Abstract Details

Title A Case Series of Neonates with Deep Medullary Vein Thrombosis

Topic Child Neurology and Developmental Neurology

Presentation(s) S8 - State-of-the-art Diagnostics in Child Neurology (5:18 PM-5:30 PM)

Poster/Presentation
Number 010

Background Deep medullary venous thrombosis (DMVT) is characterized by the formation of blood clots within the deep medullary veins of the brain, often in neonates. Advances in MRI technology have improved detection of DMVT, but there is controversy about their etiology, clinical significance, and management.

Objective We aim to better understand the clinical course of neonates with deep medullary venous thrombosis, an increasingly recognized entity in neonatal neurology.

Design/Methods We identified children with medullary venous thrombosis or congestion identified on MRI between 2008-2023 at Stanford Children’s Health. Charts were reviewed for pregnancy and delivery history, clinical presentation, MRI findings, management, and neurodevelopmental outcomes.

Results Our analysis included 64 infants with DMVT. Maternal, delivery, and neonatal comorbidities were common, including advanced maternal age (30%), pre-eclampsia/eclampsia (11%), C-section delivery (42%), hypoxic ischemic encephalopathy (22%), and congenital heart disease (22%). Most infants were neonates (median age at presentation 3 days, IQR 1-8 days). Infants presented with seizure (45%), hypotonia (20%), encephalopathy (38%), and respiratory distress (31%). Most DMVT were bilateral (69%) and often associated with parenchymal ischemic (50%) or hemorrhagic injury (36%). 15/64 patients received intervention with hyperhydration (8/15), anticoagulation (3/15), or both (4/15). 81% of patients survived to discharge, but neurologic morbidity at first follow-up visit was common, including seizures (49%), weakness (15%), spasticity (21%), hypotonia (38%), and developmental delay (55%).

Conclusions Symptomatic DVMT presents early in the neonatal period, commonly with seizures, encephalopathy, respiratory distress, and abnormal tone. Symptomatic DVMT is often bilateral and associated with concurrent parenchymal injury. The majority of infants in our cohort had associated comorbidities. Notably, our cohort had high rates of neurodevelopmental morbidity on follow up, underscoring the need for continued research into DMVT causes and treatments.

Authors/Disclosures
Gabby Barsh, MD, PhD (Stanford University) PRESENTER	Dr. Barsh has nothing to disclose.
Ria Pal, MD (Stanford)	Dr. Pal has nothing to disclose.
Elizabeth Mayne, MD (Stanford Child Neurology)	Dr. Mayne has received research support from NINDS-CNCDP K12.
Hisham Dahmoush	No disclosure on file