Abstract T P364: Carotid Narrowing and Stroke in Childhood Cavernous Sinus Thrombosis
Introduction: Cavernous sinus thrombosis (CST) is a rare and potentially life-threatening disease in children. While the incidence of neurological complication is unknown, CST can cause carotid artery narrowing, carotid vasospasm, and/or ischemia. Given the lack of data regarding childhood CST, decisions about antithrombotic and antispasmodic management remain uncertain.
Hypothesis: We describe the clinical presentation, imaging findings, treatment and outcome of childhood CST at a tertiary care center, hypothesizing that carotid narrowing and stroke are common in this condition.
Methods: We performed a single-center retrospective review of children with imaging confirmed CST from 2003-2013. Clinical data were extracted from the electronic medical record and all available imaging reviewed by two neuroradiologists. Data was analyzed with descriptive statistics.
Results: Eight patients with childhood CST (Table 1) were identified. All had carotid artery narrowing and 63% (5/8) developed ischemia. The most common complication was visual impairment secondary to infectious neuritis. Of the seven patients treated with anticoagulation, three developed new ischemia on therapy. Similar results were seen with nimodipine therapy. Despite the high incidence of stroke, outcomes were generally good, with all but one patient attaining a mRS of ≤ 1at discharge.
Conclusion: In childhood CST, carotid narrowing and arterial ischemic stroke appear to be common. While therapeutic interventions to prevent clot propagation and/or vasospasm did not prevent all new ischemia, they may have contributed to the prevention of medium/large ischemic events, which were uncommon in this series. Despite the high incidence of carotid vasospasm and stroke, outcomes were generally favorable. Large multicenter cohorts are needed to understand the preferred therapeutic strategies for childhood CST.
Author Disclosures: C.A. Press: None. A.J. Lindsay: None. L.Z. Fenton: None. N.V. Stence: None. T.J. Bernard: None. D.M. Mirsky: None.
- © 2015 by American Heart Association, Inc.