Abstract DP372: Cerebral Venous Sinus Thrombosis in Children with Iron Deficiency Anemia; a Case Series and Updated Review of the Literature

Background: Cerebral venous sinus thrombosis (CVST) in children is an uncommon but potentially devastating condition, often with infarction and long-term neurologic sequelae. CVSTs overall have been shown to affect superficial sinus preferentially compared to deep sinuses. Iron deficiency anemia (IDA) has been increasingly recognized as a contributing risk factor for thrombosis through mechanisms involving altered platelet function, endothelial damage, and increased blood viscosity. Despite growing recognition of this association, outcomes and optimal management strategies remain unclear. Methods: We conducted a retrospective chart review of four pediatric patients diagnosed with CVST and IDA at Primary Children’s Hospital between January 2023 and September 2025. Patients were enrolled in IRB-approved Mountain West Regional Pediatric Cerebrovascular Disease Registry. Imaging-confirmed infarcts were identified on MRI. A comprehensive literature review was performed to identify previously reported pediatric cases of CVST in the setting of IDA, using PubMed and relevant MeSH terms. Results: In total, 27 pediatric cases with CVST and IDA (4 institutional, 23 from literature) were reviewed. Twenty-one (78%) had involvement of the deep venous sinuses (straight sinus, vein of Galen, internal cerebral veins). Stroke was present in 20/27 (74%) of patients. Neurologic outcomes were unavailable in 3 cases. Of the 6 children without stroke and with follow up, all achieved complete recovery. For all the patients, 16/24 (67%) had full recovery without sequelae at last follow up. Outcomes differed by thrombus location: all 4/4 children with isolated superficial thrombosis recovered fully, while only 12/20 (60%) with deep thrombosis and available follow-up achieved complete recovery. Conclusion: This study represents the largest case series of IDA and CVST in pediatric patients. IDA, particularly when severe, appears to be a significant and potentially modifiable risk factor for CVST in children. Deep venous involvement seems to be likely in cases with IDA and associated with a higher risk of infarction and neurologic sequelae. There should be a high suspicion for CVST in a child presenting with neurological symptoms in the setting of IDA. Increased awareness of this association is essential for timely diagnosis and management.