Cerebral sinovenous thrombosis (CSVT) in children: what the pediatric radiologists need to know
A 14-year-old girl with T-cell acute lymphatic leukemia presented with a 1-week history of headache and left arm and leg numbness after initiation of induction therapy including L-asparaginase. MRI of the brain showed isolated cortical venous thrombosis with hyperintensity on T1weighted and diffusion-weighted (Fig. 1) images with hemorrhagic venous infarct (Fig. 1a, star). The dural venous sinuses were patent (arrow). She mainly received antiedema measures because the entity was not initially recognized. By the time the cortical vein thrombosis was identified, her neurological status had improved. L-Asparaginase therapy carries a 1–2% risk of cerebral venous thrombosis . The precise mechanism is not well understood. It is thought to be due to Lasparaginase-induced imbalance between procoagulant and anticoagulant factors . In the context of Lasparaginase therapy, a high index of suspicion and early imaging are required even for mild neurological symptoms.