The presentation, treatment, and outcome of neonatal cerebral sinovenous thrombosis (SVT) were studied in 42 children, using neurology clinic records (1986-2005) at Indiana University School of Medicine. Gestational/delivery complications occurred in 82%, including preeclampsia/hypertension in 26%, gestational diabetes (26%), and meconium aspiration in 24%. Comorbid risk factors in 62% included dehydration, sepsis, meningitis, and cardiac malformations. Seizures in 57% were the most common presenting symptom. A single sinus was involved in 50%, most commonly the sagittal sinus. Infarcts occurred in 60%, and 64% had received prothrombotic evaluations, testing negative for protein C, protein S, or antithrombin III deficiencies. Three (13%) of 24 tested were heterozygous for factor V Leiden, and 8 (42%) of 19 were positive for other prothrombin gene mutations. Three (7%) were treated with heparin sodium, and all others received only supportive care. One died, and of 41 who survived, 23 (79%) had impairments that included cognitive disorders, cerebral palsy, and epilepsy. [1]

COMMENT. SVT is a risk factor in neonates following a complicated pregnancy or birth or with acute systemic debilitating illness. Presenting symptoms include seizures, focal or generalized, focal motor deficits, and increased intracranial pressure. Diagnosis is made with MRI and venogram. The outcome is usually poor, with long-term sequelae. Fortunately, due to improved fluid therapy and antibiotics, cerebral venous thrombosis is now uncommon. In earlier times, thrombosis was usually due to sepsis of the mastoid, lip or orbit, and often as a complication of cyanotic congenital heart disease. [2]