A retrospective review of paediatric cerebral venous sinus thrombosis in a South African tertiary hospital
Date
2016-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Introduction:
Paediatric cerebral venous sinus thrombosis (CVST) is a rare complication associated with many underlying illnesses. It often results in severe neurological complications, which can be severely debilitating.
The aim is to describe the clinical presentation of paediatric patients diagnosed with CVST who presented to Tygerberg Children’s Hospital (TCH).
Materials and methods:
This is a retrospective, descriptive case series looking at patients younger than 14 years of age residing in the Western Cape who were referred to TCH and diagnosed with CVST based on neuroimaging over a six-year period.
Results:
Thirty-five patients were included in this study with a male predominance of 57% and a mean age at presentation of 17 months with the majority of patients (80%) presenting during the first year of life. The mean weight-for-age was on the -2 Z-score. Acute gastro-enteritis (AGE) was the most common underlying clinical condition associated with the development of CVST. All of the patients with AGE were hypernatraemic. The majority of our patients (62.9%) had multiple sinus involvement; the transverse sinus was the most common sinus involved. Mortality was 5.7% and morbidity 37.1%. Poor outcome was not associated with convulsions or with decreased level of consciousness at presentation.
Conclusion:
Our study is the first of its kind in South Africa. We demonstrated that hypernatraemia and AGE appear to be significant acute underlying triggers for developing CVST. In this study CVST is more common in younger patients, severe underweight for age and associated with AGE than has previously been reported in studies from high income countries.
AFRIKAANSE OPSOMMING: Inleiding: Pediatriese serebrale veneuse sinus trombose (SVST) is ‘n raar komplikasie wat kan volg op verskeie onderliggende mediese toestande. Dit kan moontlike debiliterende neurologiese komplikasies tot gevolg hê. Die doel van hierdie studie is om die kliniese beeld van pasiente te beskryf wat met SVST in Tygerberg Kinderhospitaal presenteer. Materiale en metodes: Hierdie is n retrospektiewe, deskriptiewe gevalle reeks van kinders onder 14 jaar wat met SVST gediagnoseer is in ‘n 6 jaar periode in Tygerberg Kinderhospitaal in die Wes-Kaap. Bevindinge: Vyf-en-dertig pasiënte was in die reeks ingesluit met ‘n manlike predominansie van 57%. Die gemiddelde ouderdom van die kinders was 17 maande en 80% van die kinders was jonger as 1 jaar oud. Die gemiddelde gewig-vir-ouderdom was op die -2 Z-telling. Die algemeenste onderliggende siekte-toestand wat met die ontwikkeling van SVST geassosieër was, was akute gastro-enteritis (AGE). Al die pasiënte met AGE het geassosieerde serum hipernatremie gehad. Die transverse sinus was die sinus wat die meeste geaffekteer was en in die meerderheid van die pasiënte (62.9%) was meer as 1 sinus aangetas. Morbiditeit was 37.1% met ‘n mortaliteit van 5.7%. Konvulsies en ‘n onderdrukte bewussyn met presentasie was nie geassosieer met ‘n slegte uitkoms nie. Konklusie: Hierdie studie is die eerste van sy soort in Suid-Afrika. Ons het gewys dat AGE en hipernatremie belangrike onderliggende toestande is in die ontwikkeling van SVST. In hierdie studie is SVST meer algemeen in jonger kinders, dié wat ondergewig vir ouderdom is en die wat geassosieer is met AGE as wat voorheen gepubliseer is in hoër inkomste lande.
AFRIKAANSE OPSOMMING: Inleiding: Pediatriese serebrale veneuse sinus trombose (SVST) is ‘n raar komplikasie wat kan volg op verskeie onderliggende mediese toestande. Dit kan moontlike debiliterende neurologiese komplikasies tot gevolg hê. Die doel van hierdie studie is om die kliniese beeld van pasiente te beskryf wat met SVST in Tygerberg Kinderhospitaal presenteer. Materiale en metodes: Hierdie is n retrospektiewe, deskriptiewe gevalle reeks van kinders onder 14 jaar wat met SVST gediagnoseer is in ‘n 6 jaar periode in Tygerberg Kinderhospitaal in die Wes-Kaap. Bevindinge: Vyf-en-dertig pasiënte was in die reeks ingesluit met ‘n manlike predominansie van 57%. Die gemiddelde ouderdom van die kinders was 17 maande en 80% van die kinders was jonger as 1 jaar oud. Die gemiddelde gewig-vir-ouderdom was op die -2 Z-telling. Die algemeenste onderliggende siekte-toestand wat met die ontwikkeling van SVST geassosieër was, was akute gastro-enteritis (AGE). Al die pasiënte met AGE het geassosieerde serum hipernatremie gehad. Die transverse sinus was die sinus wat die meeste geaffekteer was en in die meerderheid van die pasiënte (62.9%) was meer as 1 sinus aangetas. Morbiditeit was 37.1% met ‘n mortaliteit van 5.7%. Konvulsies en ‘n onderdrukte bewussyn met presentasie was nie geassosieer met ‘n slegte uitkoms nie. Konklusie: Hierdie studie is die eerste van sy soort in Suid-Afrika. Ons het gewys dat AGE en hipernatremie belangrike onderliggende toestande is in die ontwikkeling van SVST. In hierdie studie is SVST meer algemeen in jonger kinders, dié wat ondergewig vir ouderdom is en die wat geassosieer is met AGE as wat voorheen gepubliseer is in hoër inkomste lande.
Description
Thesis (MMed)--Stellenbosch University, 2016.
Keywords
Cerebral veins, Sinus thrombosis, Paediatrics, Gastroenteristis, Hypernatraemia, UCTD