What is cerebral venous thrombosis?
Cerebral venous thrombosis (CVT) is a rare but serious condition that is a cause of stroke in children and newborns. CVT occurs when a blood clot (thrombus) blocks blood flow within the veins draining the brain. This can occur in the large veins surrounding the brain or in the veins that course through the brain. It can lead to increased blood pressure on the venous side of circulation in the brain, and in turn impair blood flow into the brain, causing an ischemic stroke.
In addition, CVT can cause bleeding from veins in the brain and can cause a type of stroke known as a hemorrhagic venous stroke or infarction.
Cerebral Venous Thrombosis | Symptoms & Causes
What are the symptoms of cerebral venous thrombosis?
The signs and symptoms of CVT can vary depending on a child’s age. In newborns, CVT typically causes seizures, irritability, and extreme sleepiness.
Children and adolescents with CVT tend to experience additional symptoms. These usually occur together and get worse as time passes:
- severe headaches, which may cause nausea and vomiting
- dizziness or lightheadedness
- vision problems
- weakness on one side of the body
- progressive decline in mental status
What causes cerebral venous thrombosis?
A number of factors can increase a child’s risk of developing CVT. These include:
- heart disease
- sickle cell disease
- cancer and certain types of chemotherapy
- blood-clotting disorders
- chronic infections, such as ear or sinus infections that don’t heal
- serious infections, such as meningitis
- inflammatory bowel disease
Children with chronic conditions such as inflammatory bowel disease, systemic lupus erythematosus, and Cushing’s syndrome appear to be more likely to develop CVT.
Cerebral Venous Thrombosis | Diagnosis & Treatments
How is cerebral venous thrombosis diagnosed?
If a physician suspects that your child has CVT, they will conduct a physical exam and take a thorough medical history. They may also recommend certain diagnostic tests, such as:
- blood tests to check for underlying clotting problems, inflammatory conditions, or hematologic disorders
- computed tomography (CT) scans to produce images of your child’s brain
- magnetic resonance imaging (MRI) scans to produce images of your child’s brain
- lumbar puncture to check for signs of infection
How is cerebral venous thrombosis treated?
If your child experiences symptoms of CVT or stroke, you should seek immediate medical treatment. Once you have arrived at the emergency room, physicians will treat CVT based on your child’s individual case, including their age and the underlying cause of the blood clot. Treatment options include:
- intravenous fluids to address to dehydration
- medications to help prevent blood clots
- medications to help prevent seizures
- minimally invasive endovascular techniques
- rehabilitation after stroke
Previously, clinicians were reluctant to treat CVT with anticoagulants, which themselves can pose some risks, but confidence has grown in using these medications to prevent injury from the blood clot in selected newborns and children. These children are closely monitored by the Thrombosis and Anticoagulation Program at Boston Children’s, which collaborates closely with the Stroke and Cerebrovascular Center.
If medications are not enough to clear the blood clot, physicians in Boston Children’s Cerebrovascular Surgery and Interventions Center may perform endovascular thrombolysis. This emergency treatment, performed under general anesthesia during a cerebral angiogram, guides a very small catheter into a part of the brain called the cerebral venous sinus to introduce balloons, suction devices, or other tools to break up the clot or even extract it from the vessel. In some cases, clot-dissolving drugs such as tissue plasminogen activator (tPA) are delivered through the catheter, right at the blockage.
How we care for cerebral venous thrombosis
Children who have experienced a stroke as the result of CVT receive treatment from the team of experts in the Boston Children’s Hospital Stroke and Cerebrovascular Center. When surgery is necessary to remove a clot, we work with our colleagues in the Cerebrovascular Surgery and Interventions Center to coordinate seamless and state-of-the art care of children with CVT.