Cerebral Sinovenous Thrombosis in Children With Acute Bacterial Intracranial Infection.

BACKGROUND AND

OBJECTIVES

The epidemiology and optimal treatment strategy of cerebral sinovenous thrombosis (CSVT) in children with acute bacterial intracranial infection is largely unknown. We aimed to define the prevalence of CSVT among children with acute bacterial intracranial infection at a tertiary care pediatric hospital, to identify risk factors associated with the development of CSVT in this population, and to describe the use of anticoagulation in these children at our institution.

METHODS

This was a retrospective observational cohort study of children aged 1-18 years hospitalized at a tertiary care children's hospital for acute bacterial intracranial infection between January 1, 2015, and March 31, 2023. Children with bacterial meningitis/meningoencephalitis, cerebritis, intraparenchymal abscess, subdural empyema, and/or epidural abscess who had at least 1 head imaging study were included. Cases were identified using ICD codes; medical charts were manually screened to confirm diagnoses. A multivariable logistic regression model was built to identify independent risk factors for the primary outcome of CSVT using the least absolute shrinkage and selection operator technique.

RESULTS

Of 108 patients included (median age 10 years, 41% female), 33 (31%) developed CSVT. The prevalence of CSVT did not vary by year, but the absolute number of hospitalizations for acute bacterial intracranial infection rose during the study period, particularly after 2020. Presenting neurologic signs/symptoms did not differ between those who did and did not develop CSVT. Mastoiditis (adjusted odds ratio [aOR] 12.2, 95% CI 3.1-48.5), cerebritis (aOR 4.6, 95% CI 1.5-14.5), extra-axial focal suppurative infection (aOR 10.2, 95% CI 1.7-61.6), and dehydration (aOR 3.9, 95% CI 1.0-15.1) were each independently associated with CSVT. Seventy-three percent of children with CSVT (24/33) received anticoagulation (median duration 91 days) with no major bleeding events. All children with CSVT had at least partial thrombus resolution; 60% (20/33) had complete resolution.

DISCUSSION: CSVT is common in children with acute bacterial intracranial infection but difficult to clinically identify. Clinicians should maintain a high index of suspicion for CSVT in this population and consider appropriate screening imaging studies, particularly in children with mastoiditis, cerebritis, extra-axial focal suppurative infection, and/or dehydration. Anticoagulation was well-tolerated in this cohort; further studies should focus on determining its safety, benefit, and ideal duration in infection-related CSVT.