ABSTRACT
BACKGROUND AND PURPOSE: Cerebral sinovenous thrombosis is a rare disease with severe neurological sequelae. The aim of this retrospective multicenter study was to investigate the clinical course, possible risk factors, and outcome of a cohort of neonatal patients with sinovenous thrombosis and, second, to estimate the incidence in The Netherlands. METHODS: From January 1999 to March 2009, a review of all neonatal patients with sinovenous thrombosis from 6 tertiary neonatal intensive care units was performed. Population characteristics, clinical presentation, (prothrombotic) risk factors, neuroimaging, interventions, and neurodevelopment were evaluated. An estimated incidence was calculated based on the Netherlands Perinatal Registry. RESULTS: Fifty-two neonates were included (39 boys) with a median gestational age of 39 weeks (range, 30 to 42 weeks; 5 preterm). An assisted or complicated delivery occurred in 32 of 52. Presenting symptoms developed at a median postnatal age of 1.5 days (range, 0 to 28 days) and consisted mainly of seizures (29 of 52). All sinovenous thrombosis cases were confirmed with MRI/MR venography. Multisinus thrombosis was most common followed by superior sagittal sinus thrombosis. FII G20210A mutation was present in 2 of 18 tested neonates (11%). Anticoagulation therapy (in 22 of 52) did not result in hemorrhagic complications. At follow-up (median age, 19 months; range, 3 to 72 months), moderate to severe neurological sequelae were present in 38%. The mortality was 10 of 52 (19%). A variable, although high yearly incidence of 1.4 to 12 per 100 000 term newborns was found. CONCLUSIONS: Neonatal sinovenous thrombosis is a multifactorial disease. The estimated incidence in The Netherlands seems higher than reported elsewhere.
Subject(s)
Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/therapy , Venous Thrombosis/diagnosis , Venous Thrombosis/therapy , Age Factors , Female , Humans , Infant, Newborn , Intracranial Thrombosis/complications , Intracranial Thrombosis/diagnosis , Intracranial Thrombosis/therapy , Male , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , Nervous System Diseases/therapy , Retrospective Studies , Sinus Thrombosis, Intracranial/complications , Treatment Outcome , Venous Thrombosis/complicationsABSTRACT
Neurosensory hearing loss is a well-known complication of antenatally acquired cytomegalovirus (CMV) infection. We here report an infant who developed auditory neuropathy after a postnatally acquired CMV infection. Infection probably occurred through ingestion of infected breast milk. Following a cochlear implant, there is normal language perception and a mildly delayed language expression at age 4. We speculate that the long-term effects of perinatal CMV infections are more dependent on the postconceptional age at which infection occurs than on whether the infection occurs antenatally or postnatally. An early acquired neonatal CMV infection in very preterm infants may therefore have long-term neurological sequelae, including auditory deficits.
Subject(s)
Cytomegalovirus Infections/diagnosis , Diseases in Twins/diagnosis , Hearing Loss, Central/diagnosis , Infant, Premature, Diseases/diagnosis , Audiometry, Pure-Tone , Child, Preschool , Cochlear Nerve/physiopathology , Cytomegalovirus Infections/physiopathology , Cytomegalovirus Infections/transmission , Diseases in Twins/physiopathology , Evoked Potentials, Auditory, Brain Stem/physiology , Female , Follow-Up Studies , Humans , Hyaline Membrane Disease/diagnosis , Hyaline Membrane Disease/physiopathology , Infant , Infant, Newborn , Infant, Premature, Diseases/physiopathology , Intensive Care Units, Neonatal , Milk, Human/virology , Otoacoustic Emissions, Spontaneous/physiology , Polymerase Chain Reaction , Twins, DizygoticABSTRACT
BACKGROUND AND PURPOSE: Cerebral sinovenous thrombosis is a rare disorder with a high risk of an adverse neurodevelopmental outcome. Until now, anticoagulation therapy has been restricted to neonates without an associated parenchymal hemorrhage. In this study, we describe sequential neuroimaging findings and use of anticoagulation therapy in newborn infants with a unilateral thalamic hemorrhage due to cerebral sinovenous thrombosis. METHODS: Ten neonates with a unilateral thalamic hemorrhage and cerebral sinovenous thrombosis were studied. Diagnosis was suspected using cranial ultrasound and confirmed with MRI/MR venography. Eight infants had a repeat MRI at 3 to 7 months. Neurodevelopmental outcome was assessed from 3 months until 5 years. RESULTS: One infant died. Seven infants were treated with low-molecular-weight heparin. No side affects were noted. MRI showed involvement of multiple sinuses, additional intraventricular hemorrhage, and white matter lesions in all infants. Recanalization was present on the repeat MRI at 3 months in all infants. Treatment was delayed in one infant and anticoagulation was started only after extension of the thalamic hemorrhage. He required a ventriculoperitoneal drain for posthemorrhagic ventricular dilatation and developed cerebral visual impairment and global delay. Two other infants showed global delay and one of them also developed postneonatal epilepsy. Mild asymmetry in tone was present in 4 children. CONCLUSIONS: Cerebral sinovenous thrombosis was found in 10 neonates with unilateral thalamic hemorrhage. Diagnosis was suspected on cranial ultrasound and confirmed with MRI/MR venography. Treatment with low-molecular-weight heparin in newborn infants with a thalamic hemorrhage due to cerebral sinovenous thrombosis appears to be safe and should be considered. Long-term follow-up will be needed to assess cognitive outcome.
