Pediatric Cerebral Sinus Venous Thrombosis During the First Three Years of the SARS-CoV-2 Pandemic: A Multinational Case Series.

Publication date: Jul 31, 2026

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has been associated with thrombotic complications in adults and children. Cerebral sinovenous thrombosis (CSVT) has also been described in adults with SARS-CoV-2, though rarely reported in children. To describe cases of SARS-CoV-2-related pediatric CSVT among patients enrolled in the International Pediatric Stroke Study. We enrolled pediatric patients (0-18 years) with a CSVT diagnosis between March 1, 2020 and March 1, 2023, positive for SARS-CoV-2. Nineteen cases (median age: 9 years; IQR: 3-16) from 4 countries and 12 institutions met eligibility criteria. We found thrombosis of the superficial venous system in 90%, arterial ischemic strokes in 11%, and venous infarcts in 26% of patients. All patients had an additional thrombosis risk factor, including 63% with a positive hypercoagulability evaluation and coinfection present in 58%. Eighteen patients (95%) received antithrombotics. Outcome data were reported in16/19 (84%) (median follow-up of 12 months [IQR: 5-28]) showing partial recanalization in nine, full recanalization in four, and no recanalization in three. CSVT appears to be a rare thrombotic complication of pediatric SARS-CoV-2 infection. However, all patients in our case series had additional risk factors for thrombosis, making it difficult to determine the relationship between SARS-CoV-2 infection and CSVT development. The majority of patients had anticoagulation and among 16 patients with follow-up data, 80% demonstrated CSVT resolution or improvement. Despite this, 38% had neurological deficits at follow-up. These findings are consistent with those reported in previous pediatric CSVT case series.

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