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AN
UNCOMMON COMPLICATION OF IRON DEFICIENCY IN CHILDREN
WASHINGTON, DC—Iron deficiency anemia should be considered in young children with intracranial venous sinus thrombosis. So says a group of Utah physicians who described their experience with intracranial venous sinus thrombosis in three children (ages 9, 19, and 27 months) at the 31st Annual Meeting of the Child Neurology Society.
“Intracranial venous sinus thrombosis is not a common complication of iron deficiency anemia, but it is a very serious one,” said Francis M. Filloux, MD, in an interview with Neurology Reviews. Dr. Filloux is Associate Professor of Pediatric Administration at the University of Utah School of Medicine in Salt Lake City.
All three children were iron deficient at admission and had hemoglobin levels ranging from 6.6 to 7.0 mg/dL, platelet counts of 248,000 to 586,000/µL, and a mean corpuscular volume of 45 to 56 fL. Improper nutrition was the likely cause of the iron deficiency, reported Dr. Filloux and colleagues. One child’s diet consisted mainly of cow’s milk and rice, and another was fed cow’s milk almost exclusively. The third child received only goat’s milk with a folate supplement.
PRESENTATION DIFFERENCES
Each child’s course of illness differed somewhat. The first child presented with vomiting, decreased responsiveness, and right eye deviation after 10 days of fever and headache. Seizures after one week of mild rhinorrhea and cough and one day of vomiting and diarrhea characterized the second case. In the third child, presentation included lethargy and seizures after two days of mild cough, congestion, vomiting, and reduced oral intake.
Magnetic resonance venography showed thrombosis of the straight sinus and internal cerebral veins in all three children. In one child, thrombosis also occurred in the vein of Galen, in the left transverse and sigmoid sinuses, and in the upper left internal jugular vein. Evaluation for prothrombotic disorders was negative in each child.
OUTCOMES AND IMPAIRMENTS
The children’s intracranial venous sinus thrombosis treatments included thrombectomy, anticoagulation with heparin and/or warfarin, and thrombolysis with urokinase. Iron deficiencies were corrected with packed red blood cell transfusions and iron supplementation. “There is controversy as to whether anticoagulation is indicated in cases such as these,” said Dr. Filloux. Anticoagulation heightens the risk of bleeding into the brain, which is common in pediatric intracranial venous sinus thrombosis due to hemorrhagic injury, Dr. Filloux noted.
Outcomes in intracranial venous sinus thrombosis are generally favorable, although one of the children described by Dr. Filloux’s group displayed severe neurologic impairment with spastic quadriparesis, static encephalopathy, hydrocephalus, decreased vision, and seizure disorder six months after hospital admission. The other two children showed minimal impairment—mild left hemiparesis three months after admission in one case, and slight terminal tremor in the upper extremities bilaterally about two years after admission in the other case.
These children were similar in presentation, degree of iron deficiency, and outcomes to four cases of pediatric intracranial venous sinus thrombosis with iron deficiency anemia reported in the literature, according to Dr. Filloux. Pediatricians can help prevent intracranial venous sinus thrombosis in children by verifying appropriate iron intake during routine office visits, Dr. Filloux advised.
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—Timothy Begany
Suggested Reading
Belman AL, Roque CT, Ancona R, et al. Cerebral venous thrombosis in a child with iron deficiency anemia and thrombocytosis. Stroke. 1990;21:488-493.
Hartfield DS, Lowry NJ, Keene DL, Yager JY. Iron deficiency: a cause of stroke in infants and children. Pediatr Neurol. 1997;16:50-53.
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