Signs, risk factors, comorbidities, and radiographic findings in 59 neonates presenting with sinovenous thrombosis are reported from Indiana University School of Medicine, Indianapolis, IN. Thirty-nine (66%) patients presented early, within 48 hours after birth, and 20 (34%) presented late, between 2 and 28 days (median 7.5 days). Presenting signs were respiratory distress in 43 (73%), hypoxia (69%), seizures (59%), weight loss (58%), and hypotonia (58%). Early presentation was significantly associated with respiratory distress, hypoxia, hypotonia, preterm delivery, and low Apgar score; maternal preeclampsia/hypertension showed a trend toward early association. Late presentation was significantly associated with dehydration. Neonatal comorbidities included congenital cardiac disorders in 37%, anemia in 29%, cyanosis in 27%, and dehydration in 17%. Diagnosis of sinovenous thrombosis was established by CT scan in 28, MRI in 20, MR venography in 10, and ultrasound in 1. Superior sagittal sinus was involved most commonly (75%); 71% had multiple thrombosed sinuses. Infarction occurred in 54%, with associated hemorrhage in 42%. Multiple thromboses, complications and radiographic severity were not significantly correlated with time of presentation. Refractory seizures were marginally associated with hemorrhage (P=0.09). 
COMMENT. Two thirds of neonates with cerebral sinovenous thrombosis have symptoms within 48 hours after birth. Early presentation is associated with respiratory distress, hypoxia, hypotonia, and low Apgar scores; late presenters frequently have dehydration, a preventable causative factor.