Serebral Sinovenöz Trombozlu Çocuklarda Klinik ve Radyolojik Bulgular

Öz

Amaç: Serebral sinovenöz tromboz (CSVT), ileri nörogörüntüleme yöntemlerinin yaygın olarak kullanılması ile, çocuklarda giderek daha fazla tanınmaktadır. Bu çalışmada CSVT tanısı alan çocukların klinik ve radyolojik bulgularını sunmayı amaçladık.

Gereç ve Yöntemler: Bir ay – 18 yaş arasında CSVT tanısı alan çocuklar retrospektif olarak analiz edildi. Demografik özellikler ve tanı anındaki yaş, cinsiyet, başvuru semptom ve bulguları, tromboz risk faktörleri, tedavi ve prognoza dair klinik veriler değerlendirildi.

Bulgular: Çalışmaya 12 çocuk dahil edildi, 8’i erkekti. Baş ağrısı (n=7), nöbet (n=5) ve görme bozukluğu (n=4) en sık görülen başvuru semptomlarıydı. Tüm çocuklarda yüzeyel venöz sistem tutulmuştu, 5 hastada derin venoz sistem tutulumu vardı. Parenkimal tutulum 3 hastada izlendi. İki çocukta izole kortikal ven trombozu mevcuttu. Tüm çocuklarda altta yatan risk faktörleri vardı. Beş hastada yakın zamanda enfeksiyon öyküsü mevcuttu, 6 hastada Behçet hastalığı, 3 hastada mastoidit, 2 hastada lipoprotein (a) yüksekliği mevcuttu. Bir hastada akut lenfoblastik lenfoma tanısı vardı, l-asparajinaz ve steroid tedavileri alıyordu. Tüm hastalar antikoagulan tedavi aldı. Doku plazminojen aktivatörü verilen bir hastada intrakraniyal kanama gelişti. Parenkimal tutulum olan 3 hastada orta-ileri motor bozukluk gelişti. Nöbetle başvuran tüm hastalarda parenkimal tutulum vardı ve hepsi epilepsi tanısı ile izleme alındı.

Sonuç: CSVT önemli bir morbidite nedenidir. Özellikle CSVT tanısı alan büyük çocuklarda Behçet hastalığı semptom ve bulguları sorgulanmalıdır. Mastoidit çocuklarda CSVT’nin halen önemli nedenlerinden biridir.

Anahtar Kelimeler

• Sinovenöz tromboz
• Manyetik rezonans görüntüleme
• risk faktörü
• tedavi
• prognoz
• İntrakraniyal

Clinical and Radiological Findings in Children with Cerebral Sinovenous Thrombosis

Öz

Objective: Cerebral sinovenous thrombosis (CSVT) is increasingly recognized in children with advanced use of neuroimaging techniques. In this study, we aimed to present clinical and radiologic features of CSVT in children.

Material and Methods: Children aged 1 month to 18 years old diagnosed with CSVT were retrospectively analyzed. Demographic and clinical data of patients including age at diagnosis, sex, presenting symptoms and signs, risk factors for thrombosis, treatment and prognosis were collected.

Results: Twelve children were included in the study, 8 of them were male. Headache (n=7), seizures (n=5) and visual impairment (n=4) were the most common presenting symptoms. The superficial venous system was involved in all patients, in five patients deep venous system was also involved. Parenchymal involvement was present in three patients. Two children had isolated cortical vein thrombosis. All patients had underlying risk factors. Five children had recent infections, six children were diagnosed with Behçet’s disease, three with mastoiditis. High lipoprotein (a) level was found in two patients. One patient had a diagnosis of acute lymphoblastic leukemia and received l-asparaginase treatment. All patients were treated with anticoagulants. One patient received tissue plasminogen activator, complicated with intracranial bleeding. Three patients with parenchymal involvement had moderate to severe motor impairment. All patients presenting with seizure had parenchymal involvement and followed up with epilepsy.

Conclusion: CSVT causes significant morbidity. Especially in older children presenting with CSVT, symptoms and signs of Behçet’s disease should be questioned. Mastoiditis is still an important reason for CSVT in children.

Anahtar Kelimeler

• magnetic resonance imaging
• risk factors
• treatment
• prognosis
• Intracranial
• Sinus thrombosis

Kaynakça

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