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Diagnosing Pediatric Cerebral Sinus Venous Thrombosis Brain Lesions

September 15, 2009
Written by: , Filed in: Neuroradiology
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A recent study designed to evaluate the frequency and topographic distribution of brain lesions associated with cerebral sinus venous thrombosis (VT) in children published in The American Journal of Neuroradiology has concluded that cerebral sinus venous thrombosis occurs most commonly in neonates, who are more likely to develop parenchymal lesions, and more commonly hemorrhagic lesions, which are usually within the territory of the affected sinus.

The Study
71 patients diagnosed with cerebral sinus venous thrombosis over a 7-year period were evaluated. The patients were divided into 3 groups by age:

  • neonates, defined as age 0 to 28 days
  • infants, 29 days to 12 months
  • older children, 1 to 18 years.

Patients with concurrent abnormalities were excluded.

Methodology
Available MR and CT images were evaluated for characteristics of lesions associated with venous thrombosis. MR studies were performed as axial T1, T2 fast spin-echo (FSE), coronal T2 FSE, and sagittal T1.

Coronal 2D time-of-flight MR venogram (MRV) with multiple MIP reconstructed images was performed.

CT studies were performed on an 8-row multidetector CT. Noncontrast images and CT venography with 1.25-mm source images and multiplanar reconstructions were generated. Most patients had MR/MRV or CT/CTV; only 6 had both.

Results of Study:
There were 34 neonates, 10 infants, and 27 older children. The most common locations of cerebral sinus venous thrombosis for neonates and infants were the transverse sinuses, superior sagittal sinus (SSS), and straight sinus.

In older children, they were the SSS, transverse sinus, and sigmoid sinus.

In 10 neonates, there was involvement of the torcular herophili, which was not involved in any of the infants or older children.

In total, 37 of 71 children (52%) with cerebral sinus venous thrombosis had brain parenchymal lesions, which occurred in 62% of neonates, 40% of infants, and 44% of older children.

In all groups, the most common location was the frontal lobe, which in the case of infants was equal to lesions in the cerebellum.

The second location in neonates was the parietal lobe, and in older children, the thalamus.

Lesions correlated with the territory of the thrombosis in 16 of 21 cases, but in 5, all of which were in neonates, they did not, and sometimes even appeared contralateral to the thrombosis.

Hemorrhagic lesions were seen in 16 of 21 neonatal lesions, 3 of 4 infant lesions, and 4 of 12 lesions in older children.

Conclusions
Cerebral sinus venous thrombosis occurs most commonly in neonates, who are more likely to develop parenchymal lesions, and more commonly hemorrhagic lesions, which are usually within the territory of the affected sinus.

Reviewer’s Comments
The article points out that 5 neonates had lesions not associated with the location of the sinus thrombosis. All of these patients underwent CT, and the authors posit that they may have had small cortical vein thromboses that may have been detected with MR. They also posit that the higher incidence of lesions in neonates is due to lack of development of protective mechanisms and collateral pathways that develop later.

Author: Yaron Lebovitz, MD

Reference:
Teksam M, Moharir M, et al. Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis. AJNR; 2008;29 (November-December): 1961-1965

Neuroradiology Review

The Johns Hopkins University School of Medicine
Course Directors: David Yousem, MD, MBA and Doris Lin, MD, PhD Maintaining certification requires not only medical knowledge to deliver quality care but also other essential elements that must be developed and maintained throughout every radiologist’s career. Therefore, this program serves as a comprehensive review of neuro-radiology and prepares the participants to tackle imaging of the brain, spine, head and neck, as well as the vascular anatomy of the central nervous system. Click here to read more or order: Neuroradiology Review
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