PB0650 - Pediatric Cerebral Venous Thrombosis in Brazil: clinical profile, treatment and outcomes

Background: Cerebral Venous Thrombosis (CVT) is a rare disease in children with potentially serious outcomes. The main triggering factors are contiguity head and neck infections, cancer, catheter, and head trauma. Clinical symptoms are frequently nonspecific, and its recognition remains a challenge for pediatricians.

Aims: Describe the clinical profile and outcome of pediatric patients diagnosed with CVT, and to compare with the literature, and international registries.

Methods: We performed a retrospective analysis of our institutional registry of pediatric thromboembolic disease (aged < 18years) from October 2003 to August 2023. We evaluated demographics, clinical presentation, predisposing factors, thrombophilias, radiological characteristics [e.g. venous infarction or hemorrhage on computed tomography [CT] or magnetic resonance imaging [MRI] scans at admission), therapeutic interventions, and outcome.

Results: We analyzed 42 patients. The mean age was 4.8 (1 day-16.1) years old; 59.5 % were male. Headache was the most common symptom (38.1%), followed by seizure (28,6%). Major risk factors were infection (47.6%), followed by catheter (21.4%). Congenital or acquired thrombophilia occurs in 33.3% (lipoprotein (A), lupus anticoagulant, and heterozygous mutation of prothrombin G 20210A). The sagittal sinus was the most common site of thrombosis (61.9%). CT or MRI scans with contrast were performed in 67% of the patients, and at admission, fourteen patients (33.3%) presented intracranial hemorrhage, and two patients required surgical intervention. Thirty-nine patients (92.8%) received anticoagulant therapy (low molecular-weight heparin, 76.9%; unfractionated heparin, 20.5%). None patient underwent mechanical thrombectomy neither thrombolysis. Four patients (10.2%) who had been on anticoagulant therapy experienced bleeding complications (one, moderate/severe). Partial recanalization was achieved in 21 (56.8%), and complete recanalization in 16 (43.2%). Eight patients (20.5%) presented neurological sequelae. No child died due to thrombosis or treatment.

Conclusion(s): Early diagnosis and treatment can help prevent the neurological complications. Anticoagulant therapy should be started as soon as possible, depending on the stability of the bleeding.