What is Cerebral Sinovenous Thrombosis (CSVT)?

Cerebral Sinovenous Thrombosis (CSVT) occurs when a blood clot develops in a vein near the brain. Cerebral refers to the brain. Sinovenous refers to the large veins that drain the brain that are called venous sinuses.

With CSVT, the clot is in a vein that is carrying blood from the brain back to the heart. This type of clot is called a thrombus. Sometimes the blood clot goes away before it causes permanent brain damage. However, sometimes the clot remains and causes a type of stroke called a venous infarct, or may cause bleeding into the brain (brain hemorrhage).

The blood carries oxygen and other important nutrients to the brain. The brain needs oxygen to survive. When veins are blocked, the pressure in the veins "backs up" and makes it harder for blood to flow freely to brain tissue. If a part of the brain does not receive oxygen from the blood for a certain period of time, the tissue in that part of the brain will become damaged or die.

Causes

In most children, one or more causes or triggering conditions can be found. Leading causes of sinovenous thrombosis include:

• Dehydration-not having enough fluid in the body
• Ear or sinus infection that does not heal
• Heart disease
• Blood clotting disorders
• Serious infections
• Cancer and cancer treatments
• Immune system diseases including inflammatory bowel disease
• Head and neck surgery
• Accidents involving the head and neck region
• Birth control pills in teenage girls

Signs and symptoms

In children and teenagers

Children and teenagers may have one or more symptoms when they have sinovenous thrombosis. These symptoms may occur gradually or suddenly. These symptoms usually all occur together and increase in severity over hours or days without relief. They 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
• Seizure activity

In newborns and infants

• Seizures
• Extreme sleepiness
• A tendency to use only one side of their body

What you can do

• Dial 911 or go to your nearest hospital Emergency Department.
• Have your child lie flat.
• Do not give your child anything to eat or drink.
• Suggest that your local medical professional contact the CHOP Stroke Program for consultation. They may contact the CHOP operator at 215-590-1000 and ask for the Stroke team to be paged.

Testing and diagnosis

Your child's Stroke team will want to find out as much information as possible to diagnose your child's stroke and the reasons why the thrombus or clot occurred.

Physical exam

The Stroke team will perform a thorough physical exam including a neurological exam to gain more information about how your child's brain is currently working.

Blood tests

The Stroke team will request that blood tests be done to test to see if your child has any underlying blood problems that could cause a stroke.

Imaging

The Stroke team will request that various types of tests be done that will give a better picture or "image" of your child's brain. These tests may include computed tomography (CT) scans, CT Venogram, magnetic resonance imaging (MRI), and magnetic resonance venogram (MRV). If the Stroke Program team feels more information about your child's heart may be useful, they may order an echocardiogram.

Other tests

Depending on your child's symptoms, the Stroke team may feel a need to order some other tests. These may include a lumbar puncture (LP) also known as a "spinal tap" to look for signs of infection or inflammation that may have caused the stroke.

Treatment

Immediately after the thrombosis or clot, your child's treatment will focus on things that will prevent the stroke from getting worse. This will include ensuring that your child has enough fluids (given through an IV or intravenous needle typically put in a vein in the child's arm or hand) and keeping the child's head elevated. Medications for any pain symptoms may be given as well. Further treatment will depend on the suspected cause of the stroke. Some treatment may focus on preventing the blood clot from getting bigger. In this case anticoagulant ("anti-clot") medications (such as COUMADIN, HEPARIN or LOVENOX) or an antiplatelet medication such as aspirin (that prevents blood platelets from clumping together to form a clot) may be prescribed.

Outlook and follow-up care

How much the thrombosis will affect your child's day-to-day life depends on the location and severity of the clot, and on whether there was brain tissue damage (venous infarct or hemorrhage). Some strokes cause mild problems. Some cause more severe problems. Some children may continue to have seizures.

The Stroke team will consult with the Rehabilitation team for advice on how best to help your child recover. Rehabilitation is a structured series of exercises to help your child recover from the effects of the thrombosis. Therapy usually begins within 48 hours of admission, provided your child is medically stable and is able to tolerate these activities. Members of the Rehabilitation team may include a physical therapist (PT), occupational therapist (OT), speech therapist, neuropsychologist and physiatrist ("rehab" or "PM&R" Physician).

Depending on the results of their assessments, it may be recommended that your child have further rehabilitation. This rehabilitation could range from a stay in the inpatient rehabilitation unit, to Day Hospital rehabilitation, to outpatient rehabilitation appointments. Rehabilitation may last from weeks to months depending on your child's needs.

It's important to keep in mind that children recover more quickly from a stroke as compared to adults. Members of the Stroke team and the Rehabilitation team will continue to assist you and your child in the recovering process and help your child return to a more normal lifestyle as soon as possible. If your child is school age, we will work with your child's school to recommend any needed changes to your child's curriculum and school day.