Pediatric Cerebral Sinus Venous Thrombosis During the First Three Years of the SARS‐CoV‐2 Pandemic: A Multinational Case Series
Marcela Torres, Allyson Schenk, Riten Kumar, Laura Lehman, Sahar M. A. Hassanein, Catherine Amlie‐Lefond, Timothy J. Bernard, Beth Anne Cavanaugh, Arpita Lakhotia, Nomazulu Dlamini, Jonathan D. Santoro, J. Michael Taylor, Yenny C. Zuñiga, Lauren A. Beslow,ABSTRACT
Background
Coronavirus disease 2019 (COVID‐19), caused by SARS‐CoV‐2, has been associated with thrombotic complications in adults and children. Cerebral sinovenous thrombosis (CSVT) has also been described in adults with SARS‐CoV‐2, though rarely reported in children.
Objective
To describe cases of SARS‐CoV‐2‐related pediatric CSVT among patients enrolled in the International Pediatric Stroke Study.
Methods
We enrolled pediatric patients (0–18 years) with a CSVT diagnosis between March 1, 2020 and March 1, 2023, positive for SARS‐CoV‐2.
Results
Nineteen cases (median age: 9 years; IQR: 3–16) from 4 countries and 12 institutions met eligibility criteria. We found thrombosis of the superficial venous system in 90%, arterial ischemic strokes in 11%, and venous infarcts in 26% of patients. All patients had an additional thrombosis risk factor, including 63% with a positive hypercoagulability evaluation and coinfection present in 58%. Eighteen patients (95%) received antithrombotics. Outcome data were reported in16/19 (84%) (median follow‐up of 12 months [IQR: 5‐28]) showing partial recanalization in nine, full recanalization in four, and no recanalization in three.
Conclusion
CSVT appears to be a rare thrombotic complication of pediatric SARS‐CoV‐2 infection. However, all patients in our case series had additional risk factors for thrombosis, making it difficult to determine the relationship between SARS‐CoV‐2 infection and CSVT development. The majority of patients had anticoagulation and among 16 patients with follow‐up data, 80% demonstrated CSVT resolution or improvement. Despite this, 38% had neurological deficits at follow‐up. These findings are consistent with those reported in previous pediatric CSVT case series.