Researchers involved with the International Pediatric Stroke Study enrolled 341 neonates with cerebral sinovenous thrombosis (CSVT) from 10 countries from 2003 through 2007. Neuroimaging findings, available in 67 of 84 term neonates with isolated CSVT, included venous ischemic infarction in 5, hemorrhagic infarction in 13, both infarction and hemorrhage in 26, and no parenchymal lesions in 23. Treatment data, available for 81/84 neonates, included antithrombotic medications in 52% (n=43) as follows: heparin (14), low molecular weight heparin (34), warfarin (1), and aspirin (2). Deep venous system thrombosis (P=0.05), and location in the US (P=0.001) predicted non-treatment with antithrombotic medications. Presence of infarction, hemorrhage, dehydration, systemic illness, and age did not predict treatment or non-treatment. On multivariant analysis, only geographic location was a significant predictor of treatment or non-treatment. [1]

COMMENT. Treatment of neonatal cerebral sinovenous thrombosis in international centers is variable and regional, and the indications and choice of antithrombotic medications are poorly defined. In an editorial, Massicotti MP et al. emphasize the importance of defining the “best” care for neonates with CSVT [2]. The long-term outlook for neonatal CSVT is estimated to be severe, with disabilities up to 58% with developmental delay, 28% cerebral palsy, and 20% seizure disorders [3]. The American Heart Association recommends antithrombotic therapy for neonates with severe thrombophilic disorders, multiple emboli, or propagating CSVT.