Cerebral venous thrombosis and deep medullary vein thrombosis: Padua experience over the last two decades

Abstract Background: Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that constitutes 20% of perinatal strokes. The incidence of CVT ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT. Materials and Methods: Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI), a national thrombosis registry. Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol. Results: Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT without DMVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15, DMVT associated with CVT in another localization in 6/15). Symptom onset occurred in the first week of life (median 8 days, IQR 4-14) with a male prevalence of 59%. The most common risk factors were complicated delivery in 38% of cases, prematurity in 40% of all patients, congenital heart diseases (48%), and infections (40% of newborns). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT compared to patients with CVT without DMVT (78% vs. 11%, p=0.013). Antithrombotic treatment was initiated in 30% of the total, and admission to the NICU was required in 87% of patients with isolated DMVT. Neurological impairment was observed in 48% of cases at discharge. Conclusions: Our study investigates a CVT, a rare subtype of perinatal stroke, showing that DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients.