Cerebral Sinovenous Thrombosis or CSVT occurs when a blood clot develops in a vein near the brain. Cerebral refers to the brain. Sinovenous refers to the large veins that drain the brain that are called venous sinuses. With CSVT the clot is in a vein that is carrying blood from the brain back to the heart. This type of clot is called a thrombus. Sometimes the blood clot goes away before it causes permanent brain damage. However, sometimes the clot remains and causes a type of stroke called a venous infarct, or may cause bleeding into the brain (brain hemorrhage). Ischemia or ischemic comes from the Greek word to "keep back" or "stop" the supply of blood to an area.
The blood carries oxygen and other important nutrients to the brain. The brain needs oxygen to survive. When veins are blocked, the pressure in the veins "backs up" and makes it harder for blood to flow freely to brain tissue. If a part of the brain does not receive oxygen from the blood for a certain period of time, the tissue in that part of the brain will become damaged or die.
Children and teenagers may have one or more symptoms when they have sinovenous thrombosis. These symptoms may occur gradually or suddenly. These symptoms usually all occur together and increase in severity over hours or days without relief. They include:
In most children, one or more causes or triggering conditions can be found. Leading causes of sinovenous thrombosis include:
The Stroke Team will want to find out as much information as possible to diagnose your child's stroke and the reasons why the thrombus or clot occurred.
The Stroke Team will perform a thorough physical exam including a neurological exam to gain more information about how your child's brain is currently working.
The Stroke Team will request that blood tests be done to test to see if your child has any underlying blood problems that could cause a stroke. Please see our Glossary for definitions of some of these tests.
The Stroke Team will request that various types of tests be done that will give a better picture or "image" of your child's brain. These tests may include Computed Tomography (CT) scans, CT Venogram, Magnetic Resonance Imaging (MRI), and Magnetic Resonance Venogram (MRV). If the Stroke Team feels more information about your child's heart may be useful, they may order an echocardiogram. Please see our Glossary for definitions of some of these tests.
Depending on your child's symptoms, the Stroke Team may feel a need to order some other tests. These may include a lumbar puncture (LP) also known as a "spinal tap" to look for signs of infection or inflammation that may have caused the stroke. Please see our Glossary for definitions of some of these tests.
Immediately after the thrombosis or clot, your child's treatment will focus on things that will prevent the stroke from getting worse. This will include ensuring that your child has enough fluids (given through an IV or intravenous needle typically put in a vein in the child's arm or hand) and keeping the child's head elevated. Medications for any pain symptoms may be given as well. Further treatment will depend on the suspected cause of the stroke. Some treatment may focus on preventing the blood clot from getting bigger. In this case anticoagulant ("anti-clot") medications (such as COUMADIN, HEPARIN or LOVENOX) or an antiplatelet medication such as aspirin (that prevents blood platelets from clumping together to form a clot) may be prescribed.
How much the thrombosis will affect your child's day-to-day life depends on the location and severity of the clot, and on whether there was brain tissue damage (venous infarct or hemorrhage). Some strokes cause mild problems. Some cause more severe problems. Some children may continue to have seizures. The Stroke Team will consult with the Rehabilitation Team for advice on how best to help your child recover. Rehabilitation is a structured series of exercises to help your child recover from the effects of the thrombosis. Therapy usually begins within 48 hours of admission, provided your child is medically stable and is able to tolerate these activities. Members of the Rehabilitation Team may include a Physical Therapist (PT), Occupational Therapist (OT), Speech Therapist, Neuropsychologist and Physiatrist ("Rehab" or "PM &R" Physician).
Depending on the results of their assessments, it may be recommended that your child have further rehabilitation. This rehabilitation could range from a stay in the inpatient rehabilitation unit, to Day Hospital rehabilitation, to outpatient rehabilitation appointments. Rehabilitation may last from weeks to months depending on your child's needs. It is important to keep in mind that children recover more quickly from a stroke as compared to adults. Members of the Stroke Team and the Rehabilitation Team will continue to assist you and your child in the recovering process and help your child return to a more normal lifestyle as soon as possible. If your child is school age, we will work with your child's school to recommend any needed changes to your child's curriculum and school day.
Reviewed by: Rebecca N. Ichord, MD
Date: October 2006