Pediatric cerebral sinovenous thrombosis (CSVT)

What is pediatric cerebral sinovenous thrombosis (CSVT)?

A cerebral sinovenous thrombosis or CSVT occurs when a blood clot forms and blocks a vein in the brain. When this happens, blocked blood flow can cause a hemorrhage or stroke.

This is uncommon in children, but we offer a high level of expertise in treating children when it does occur. Children who have a clotting disorder are at higher risk of cerebral sinovenous thrombosis.

At The Center for Cerebrovascular Disorders we are among the very best in the region at performing the most advanced procedures and therapies for the treatment of pediatric cerebrovascular disease. Each of our primary team members works solely in the pediatric setting with a clinical interest in disorders of the cerebrovascular system.

This program is the only one of its kind in Texas, and one of a handful across the nation. It offers a unique level of expertise in the management and treatment of patients with cerebral sinovenous thrombosis specific to children and adolescents. We are the only program in Dallas to offer pediatric neurosurgery and neuro-radiology coverage 24 hours a day by dedicated, pediatric specialized providers.

Please email ccdc@childrens.com to schedule an appointment.

What are the signs and symptoms of pediatric cerebral sinovenous thrombosis (CSVT)?

In newborns, symptoms include:

• Seizures

• Extreme sleepiness

• A tendency to use only one side of the body

In children and teens, symptoms include:

• Severe headache, especially with vomiting, sleepiness, or double vision

• Trouble seeing clearly in one or both eyes

• Severe dizziness or unsteadiness that may lead to losing balance or falling

• Seizures

• Stroke-like symptoms of weakness on one side of the body, slurred speech, tingling or numbness in the arms or legs

• Loss of consciousness

Most often, the condition becomes apparent after a brain hemorrhage or a stroke.

How is pediatric cerebral sinovenous thrombosis (CSVT) diagnosed?

Cerebral sinovenous thrombosis is typically found after the vein has hemorrhaged or the child has experienced stroke symptoms.

If your doctor suspects a cerebral sinovenous thrombosis, diagnostic tests may include:

• Duplex ultrasound - This procedure uses an instrument that produces high-frequency sound waves, which bounce off red blood cells. A duplex ultrasound can estimate how fast blood flows by measuring the rate of change in its pitch (frequency).

• MRI with Magnetic Resonance Angiography (MRA) - This procedure uses radiofrequency to create accurate two- and three-dimensional images of the brain and arteries in the neck and head.

• Computed Tomography (CT) Scan - This medical test uses X-rays to produces multiple three-dimensional pictures of the brain.

• Blood tests - These tests can check for medical conditions that increase the risk of blood clots

• Cerebral angiogram - This test is performed by an interventional radiologist who specializes in the care of children. This is extremely important as children have smaller blood vessels, limitations on dye administration, and specific radiation recommendations.

  • The cerebral angiogram is a minimally invasive procedure which uses a special contrast, or dye, to observe blood flow in the brain. During the procedure, the radiologist places a small IV or catheter in a blood vessel in the groin, which he or she then uses to reach the blood vessels that supply the brain. With the help of the special contrast or dye, an X-ray machine moves in different angles and takes pictures of the blood vessels. A team consisting of a radiologist, anesthesiologist, radiology technologists, and nurses will care for your child throughout the procedure.

  • Following the procedure, your child will have to lie flat for approximately four hours due to puncture of a large blood vessel in the groin, as this decreases the risk of bleeding. If needed, your child will receive medication to help him or her relax and rest during this time.

What are the causes of pediatric cerebral sinovenous thrombosis (CSVT)?

A cerebral sinovenous thrombosis is a very rare condition that can occur in children with complex medical problems and in those with blood disorders that increase the tendency for the blood to form clots. In some cases the cause can be an ear or sinus infection that will not heal, in which case the underlying cause must also be treated.

How is pediatric cerebral sinovenous thrombosis (CSVT) treated?

Additional medical management is provided through collaboration with neurology and our intensive care medical teams.

• We offer a comprehensive approach to treating children with CSVT.  In many instances children with CSVT can be managed medically with collaboration of our team and the expertise of hematology.

• In severe cases, an endovascular thrombolysis is performed. This is a minimally invasive procedure that uses the same technique and imaging process as an angiogram, in which the radiologist guides the catheter to the area where the clot is located.

  • With this procedure, special techniques and equipment are used to break up the clot in the brain and continuous medications are administered to assist with dissolving the clot. Depending on the severity of the clot, some children require multiple treatments or procedures. Our team partners with the critical care team in management of your child’s care during this treatment.