PB0277 - Outcomes of Cerebrosinovenous thrombosis in infants and children

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

MM

Marilyn J. Manco-Johnson

Professor of Pediatrics
University of Colorado Hemophilia & Thrombosis Center
Aurora, Colorado, United States

Presenting Author(s)

VT

Vivian Thompson

Research Assistant
University of Colorado Hemophilia & Thrombosis Center
Aurora, Colorado, United States

Co-Author(s)

DT

Dianne Thornhill

Statistician
University of Colorado Hemophilia & Thrombosis Center
Aurora, Colorado, United States
CN

Cindy Nederveld

Nurse Coordinator
University of Colorado Hemophilia & Thrombosis Center
Aurora, Colorado, United States
JS

Julie Smith

Research Manager
University of Colorado Hemophilia & Thrombosis Center
Aurora, Colorado, United States
TS

Timothy Smith

Research Assistant
University of Colorado Hemophilia &b Thrombosis Center
Aurora, Colorado, United States
NS

Nicholas Stence

Professor of Radiology
University of Colorado
Aurora, Colorado, United States
TB

Timothy Bernard

Professor of Pediatrics
University of Colorado Hemophilia & Thrombosis Center
Aurora, Colorado, United States

Background: Cerebrosinovenous thrombosis (CSVT) comprises 20% of venous thrombosis in pediatrics. DeVeber and colleagues previously reported poor outcomes of pediatric CSVT with 8% mortality and 38% abnormal neurologic outcome, of which 80% were motor (NEJM 2001;345:417).

Aims: With advances in diagnosis, treatment and follow-up through dedicated Pediatric Thrombosis Centers, we sought to determine current outcomes of CSVT.

Methods: Analysis of a consented, prospective inceptional cohort study of thrombosis and thrombophilia. Eligibility included infants and children diagnosed with CSVT followed in a multidisciplinary stroke clinic. Clinical data were extracted from the electronic medical record. Adverse outcomes included mortality, thrombus recurrence, headache, seizures, enrollment in occupational (OT), physical (PT) or speech (ST) therapy, an individualized educational plan (IEP) or being behind grade level in school, assessed 6 or more months following CSVT.

Results: Ninety-five children with CSVT were identified, with a disproportion of neonates and infants. Mean follow-up was 3.2 years, SD 3.5. Table 1 show demographics, risk factors and treatment. There was male predominance overall; infection and positive family history were common in both. The majority of children received more than 12 weeks of anticoagulation. Infants were more likely to get no anticoagulation, but were not more likely to bleed on anticoagulation. Table 2 show outcomes with a low rate of death and recurrence limited to older children. Older children were more likely to suffer chronic headache. All other adverse outcomes predominated in neonatal and infant CSVT. Adverse outcomes did not relate to clot size (p=0.32), anticoagulation duration (p=0.24), thrombophilia (p=0.8) or bleeding on anticoagulation (p=0.2).

Conclusion(s): Mortality and thromboembolism recurrence are infrequent in pediatric CSVT. Long-term neurologic morbidity with seizure, motor, speech and learning difficulties are common following CSVT in neonates and infants. Future research should address risk factors, predictors and better therapies to prevent or ameliorate adverse neurologic outcomes of CSVT in infants.