Epidemiology, Clinical Features, and Outcome in a Cohort of Adolescents With Cerebral Venous Thrombosis.

Abstract

OBJECTIVE\nWe aimed to analyze the epidemiological, clinical, and paraclinical features of adolescents with cerebral venous thrombosis (CVT) and its therapeutic management and outcome.\n\n\nMETHODS\nThis multicenter retrospective cohort included patients aged 10-18 years hospitalized for a first episode of CVT in two French regions between 1999 and 2019. The number of cases was compared to the number recorded by the French health insurance system. The Lariboisière hospital s CVT registry allowed comparisons with adults.\n\n\nRESULTS\n102 patients were included (52·9% female;median age 15·1 years). Estimated incidence was 0·37-0·38/100,000 adolescents/year. 45·5% of patients presented with focal deficits or seizures or in a coma. Male patients were younger than female patients (14·2 vs 15·6 years;p<0·01) and more often admitted to intensive care (52·1% vs 24·1%;p=0·0035). The lateral sinus was the most common CVT location (72·3%), and 29·4% of adolescents had associated venous infarction and/or hematoma. Most patients (94·1%) received anticoagulation. Treatment also included an endovascular procedure (2·9%), decompressive craniectomy (4·9%), and CSF shunt (6·9%). The most frequently identified CVT-associated condition was local infection in male (18·6%) and systemic disease in female patients (14·8%;p<0·001). The proportion of CVTs in adolescents without an identified associated condition or risk factor was low (1·9% vs 11·4% in adults;p<0·002). Adverse outcome at 1 year was more frequent than in adults (33·3% vs 11·8%;p=0·0001).\n\n\nINTERPRETATION\nCVT in adolescents is rare and complex, with specific epidemiology, including differences in clinical presentation and associated conditions between sexes, and more severe outcomes than in adults. Careful specialized management and follow-up are therefore recommended.