Anticoagulation Therapy and Imaging in Neonates With a Unilateral Thalamic Hemorrhage Due to Cerebral Sinovenous Thrombosis
Anticoagulation Therapy and Imaging in Neonates With a Unilateral Thalamic Hemorrhage Due to Cerebral Sinovenous Thrombosis
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DOI：
10.1161/strokeaha.109.554790
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发表时间：
2009-08-01
期刊：
影响因子：
8.3
通讯作者：
Groenendaal, Floris
中科院分区：
文献类型：
--
作者：
Kersbergen, Karina J.;de Vries, Linda S.;Groenendaal, Floris
背景和目的-脑窦静脉血栓形成是一种罕见的疾病，具有不良神经发育结局的高风险。到目前为止，抗凝治疗仅限于无相关脑实质出血的新生儿。在这项研究中，我们描述了顺序的神经影像学检查结果和使用抗凝治疗的新生儿单侧丘脑出血由于脑sinovenous thrombosis. Methods-10个新生儿单侧丘脑出血和脑sinovenous thrombosis进行了研究。使用头颅超声怀疑诊断，并通过MRI/MR静脉造影术证实。8名婴儿在3至7个月时重复MRI。神经发育结果进行了评估，从3个月到5 years.Results-One婴儿死亡。7名婴儿接受了低分子量肝素治疗。未发现副作用。MRI显示所有婴儿均累及多个鼻窦、额外的脑室内出血和白色病变。所有婴儿在3个月时重复MRI均显示再通。1例婴儿延迟治疗，仅在丘脑出血扩大后开始抗凝治疗。他需要脑室腹腔引流以治疗出血后脑室扩张，并出现脑视觉障碍和全球延迟。另外两名婴儿表现出全球延迟，其中一人还发展为新生儿后癫痫。轻度不对称音存在于4 child. Conclusion-Cerebral窦静脉血栓形成被发现在10个新生儿单侧丘脑出血。诊断怀疑在颅超声和MRI/MR静脉造影证实。低分子肝素治疗脑窦静脉血栓形成所致丘脑出血的新生儿似乎是安全的，应予以考虑。需要长期随访以评估认知结果。（中风。2009; 40：2754-2760。）
Background and Purpose-Cerebral sinovenous thrombosis is a rare disorder with a high risk of an adverse neurodevelopmental outcome. Until now, anticoagulation therapy has been restricted to neonates without an associated parenchymal hemorrhage. In this study, we describe sequential neuroimaging findings and use of anticoagulation therapy in newborn infants with a unilateral thalamic hemorrhage due to cerebral sinovenous thrombosis.Methods-Ten neonates with a unilateral thalamic hemorrhage and cerebral sinovenous thrombosis were studied. Diagnosis was suspected using cranial ultrasound and confirmed with MRI/MR venography. Eight infants had a repeat MRI at 3 to 7 months. Neurodevelopmental outcome was assessed from 3 months until 5 years.Results-One infant died. Seven infants were treated with low-molecular-weight heparin. No side affects were noted. MRI showed involvement of multiple sinuses, additional intraventricular hemorrhage, and white matter lesions in all infants. Recanalization was present on the repeat MRI at 3 months in all infants. Treatment was delayed in one infant and anticoagulation was started only after extension of the thalamic hemorrhage. He required a ventriculoperitoneal drain for posthemorrhagic ventricular dilatation and developed cerebral visual impairment and global delay. Two other infants showed global delay and one of them also developed postneonatal epilepsy. Mild asymmetry in tone was present in 4 children.Conclusions-Cerebral sinovenous thrombosis was found in 10 neonates with unilateral thalamic hemorrhage. Diagnosis was suspected on cranial ultrasound and confirmed with MRI/MR venography. Treatment with low-molecular-weight heparin in newborn infants with a thalamic hemorrhage due to cerebral sinovenous thrombosis appears to be safe and should be considered. Long-term follow-up will be needed to assess cognitive outcome. (Stroke. 2009; 40: 2754-2760.)