Neonatal Cerebral Sinovenous Thrombosis Post–Therapeutic Hypothermia in Perinatal Asphyxia: A Case Report

Abstract

Cerebral sinovenous thrombosis (CSVT) is an uncommon condition in neonates and often leads to adverse neurodevelopmental outcomes. A high index of suspicion for CSVT is mandated for asphyxiated infants, especially following therapeutic hypothermia (TH). Magnetic resonance venography can assist in the early detection of CSVT in suspected cases. Timely initiation of anticoagulation therapy prevents thrombus propagation and allows recanalization at around 6 to 12 weeks. Long-term follow-up is essential as cognitive impairment, motor dysfunctions, and epilepsy are common complications. Herein, we describe the clinical course of a term infant who developed CSVT in the first week of life following TH for perinatal asphyxia, its management strategies, and short-term follow-up till infancy.

Keywords

perinatal asphyxia - low/middle-income countries - complications - anticoagulation

Publication History

Received: 09 October 2022

Accepted: 22 November 2022

Article published online:
26 December 2022

• References

• 1 deVeber GA, Kirton A, Booth FA. et al. Epidemiology and outcomes of arterial ischemic stroke in children: the Canadian Pediatric Ischemic Stroke Registry. Pediatr Neurol 2017; 69: 58-70
• 2 Ramenghi LA, Cardiello V, Rossi A. Neonatal cerebral sinovenous thrombosis. Handb Clin Neurol 2019; 162: 267-280
• 3 Sorg A-L, Von Kries R, Klemme M. et al. Incidence and risk factors of cerebral sinovenous thrombosis in infants. Dev Med Child Neurol 2021; 63 (06) 697-704
• 4 Filip C, Zonda GI, Vasilache I-A. et al. Neonatal cerebral sinovenous thrombosis and the main perinatal risk factors-a retrospective unicentric study. Children (Basel) 2022; 9 (08) 1182
• 5 Herman I, Karakas C, Webber TA. et al. Clinical profile and long-term outcome in neonatal cerebral sinus venous thrombosis. Pediatr Neurol 2021; 121: 20-25
• 6 Azzopardi D, Brocklehurst P, Edwards D. et al; TOBY Study Group. The TOBY study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008; 8 (01) 17
• 7 Radicioni M, Bini V, Chiarini P. et al. Cerebral sinovenous thrombosis in the asphyxiated cooled infants: a prospective observational study. Pediatr Neurol 2017; 66: 63-68
• 8 Moharir MD, Shroff M, Pontigon AM. et al. A prospective outcome study of neonatal cerebral sinovenous thrombosis. J Child Neurol 2011; 26 (09) 1137-1144
• 9 Ferriero DM, Fullerton HJ, Bernard TJ. et al; American Heart Association Stroke Council and Council on Cardiovascular and Stroke Nursing. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2019; 50 (03) e51-e96
• 10 Monagle P, Chalmers E, Chan A. et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2008; 133 (6, Suppl): 887S-968S