Neonatal cerebral venous sinus thrombosis. Diagnosis, management and outcome – a short case series

Abstract

Background. Cerebral venous sinus thrombosis (CVST) is considered a rare condition in neonates. We present the experience of our unit in the diagnosis and management of inborn patients with CVST, in order to increase awareness of this condition and the chances of early diagnosis and management. Material and method. We present three cases of patients born in our department between 2019-2022 with CVST. There are reviewed: the history, the symptomatology in the neonatal period, the imaging findings and the treatment in the hospital. In all the cases the diagnosis was suspected after an ultrasound examination and confirmed by MRI. After discharge from the hospital the patients were followed by the pediatric neurologist and were included in an early intervention program for motor and occupational therapy. There are also reviewed the motor, cognitive and language outcomes of the patients. Results. The first case is represented by the term neonate with seizures at 40 hours of age. The seizures were controlled by levetiracetam. The ultrasound and MRI showed lesions with a venous topography of different ages. The patient developed unilateral motor deficit delayed milestones, and cognitive and language impairment. The second case is an asymptomatic neonate diagnosed at 3 days of life by a routine ultrasound with right-sided intraparenchymal and interhemispheric hematomas and CSVT. The patient developed a head growth deficit and motor delay. The third case is a term LGA neonate with respiratory distress that was diagnosed with a white matter lesion and an old CVST. The patient presented with a mild motor deficit Conclusion. The diagnosis of CVST requires a high awareness about the risk factors, the presenting symptoms and ultrasound suggestive findings – this in turn leads to an appropriate indication for MRI confirmation of the lesions and a better prognosis because the appropriate treatment could be provided and the patient could be included in an early intervention program in order to decrease de incidence and severity of the long-term neuro-behavioral consequences.