Cerebral Sinovenous Thrombosis Post Head Injury - 10 Year Experience in Children.

Cerebral sinovenous thrombosis (CSVT) post head injury is infrequently diagnosed in children. We retrospectively reviewed 323 patients with histories of head injury and a computerized tomography scan of the head from June 1996 to June 2005. Twelve patients (3.7%) were diagnosed with CSVT. The mean age was 6 years (range from 2 to 15 years). Male to female ratio was 10:2. The mechanism of injury included motor vehicle accidents in 5 patients, and falls in 7 patients. Nine patients had minor head injuries (GCS> 8) whereas 3 patients had severe head injuries (GCS<8). The most common presenting symptom was vomiting in 5 patients and other less common symptoms including: headache, seizure and irritability. The commonest locations of thrombosis were sigmoid and transverse sinus. Four patients had extensive thrombus involving more than 3 sinuses. Of the 12 patients, 9 (75%) patients had skull fractures and 6 (50%) had epidural hematomas in association with CSVT. Seven patients (58%) received anticoagulant treatment. The duration of anticoagulant therapy was from 2 days to 6 months. Anticoagulation was discontinued in 3 patients (25%) due to extension of CNS bleeding. All patients receiving anticoagulation were therapeutic with an anti-factor Xa level of 0.5–1 units/mL on enoxaparin, 0.35–0.7 units/mL on standard heparin and INR level of 2–3 on Coumadin. There was complete resolution in 6 patients with the imaging done in a mean followup of 78.5 days, partial resolution in 3 patients with the mean followup imaging in 95.6 days, unchanged status in 1 patient 6 days after the diagnosis and no followup imaging in 2 patients. Six patients had thrombophilic work-up and all were normal. Of the 7 patients with full recovery, 3 patients did not receive anticoagulation. Four patients had seizure and headache, left hemiparesis, panhypopituitarism and optic atrophy, and attention deficit disorder, respectively. In conclusion, the prevalence of CSVT post head injury in children was approximately 3.7%. The etiology of CSVT in this situation might be associated with skull fracture and hematoma, which could compress the cerebral sinus. Large prospective studies involving multiple centers are required to ascertain whether prothrombotic investigations are necessary and if anticoagulation improves neurologic outcome in patients with CVST post head injury.