Prolonged direct catheter thrombolysis of cerebral venous sinus thrombosis in children: a case series.

Abstract

Cerebral venous sinus thrombosis is a rare condition with potentially devastating neurologic outcome--death and severe disability are common in advanced cases. In adults, protocols for mechanical clot disruption and direct thrombolysis are established; no guidance exists for children. We present our experience of 6 children with cerebral venous sinus thrombosis and ominous clinical progression. We found that effective thrombolysis required substantially longer infusion, more rounds of mechanical disruption, and higher doses of thrombolytics than are commonly practiced. Despite pervasive thrombosis, prethrombolysis hemorrhage, coma, and other predictors of death and disability, our patients survived and 4 of 6 had no functional deficits. One patient had moderate, and one had severe deficits. We report these cases to illustrate that hemorrhage may not be a contraindication to thrombolysis for cerebral venous sinus thrombosis, that prolonged infusion may be required to restore perfusion, and that good neurologic outcomes can be achieved despite dire clinical presentations and extensive sinus thrombosis.

• Authors: Jeff Waugh, Patricia Plumb, Nancy Rollins, Michael M Dowling
• Journal: Journal of child neurology (J Child Neurol) Vol. 27 Issue 3 Pg. 337-45 (Mar 2012) ISSN: 1708-8283 [Electronic] United States
• PMID: 22190502 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Child
• Humans
• Intracranial Thrombosis (complications, diagnosis, therapy)
• Magnetic Resonance Angiography
• Male
• Sinus Thrombosis, Intracranial (complications, diagnosis, surgery)
• Thrombolytic Therapy (adverse effects, methods)
• Tomography, X-Ray Computed
• Treatment Outcome
• Vascular Surgical Procedures (adverse effects, methods)