ORIGINAL ARTICLE Bali Medical Journal (Bali Med J) 2019, Volume 8, Number 2: 469-473 P-ISSN.2089-1180, E-ISSN.2302-2914 469 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj CrossMark Published by DiscoverSys ABSTRACT Introduction: The incidence rate of Cerebral Venous Thrombosis (CVT) in children has been increased quite significantly due to the availability of advanced imaging technology and the trends of increasing awareness about health-related problem. Systemic anticoagulant was mainstay treatment for CVT. The author proposed a method of heparin deliveries through existing Digital Subtraction Angiography (DSA) procedure called Intra-arterial Heparin Flushing (IAHF). The safety of this procedure in children was still few known and reported. The purpose of this study is to provide insights on CVT and the potential complication of IAHF as the primary therapeutic modality. Methods: This was a descriptive longitudinal study involving all patients with age 0-18 years diagnosed with Cerebral Venous Thrombosis whom admitted in RSPAD Gatot Soebroto from 2016 to 2018 through MRI examination and will undergo IAHF Procedure as the primary treatment. All subject had signed informed consent regarding the nature of the study. The descriptive data were presented in tables and narratives. Results: The study found that the highest age group found in this study was between 6-12 years old (46,6%) with male-predominant (70,6%). The origins of the patients were mostly from Indonesia (88%) and several from Vietnam (12%). The most common symptoms of CVT in this study was the speech/communication problem (12%). The most common complication after IAHF procedure was wound swelling at the puncture site (2,6%). Conclusion: CVT predominantly affect male aged 6-12 years old with speech problem was the most common symptoms. IAHF procedure shown minimal side effects in pediatric with CVT. Keywords: Cerebral venous thrombosis, Heparin flushing, Intraarterial, IAHF, DSA Cite this Article: Pramono, A., Soetikno, R., Kartamihardja, A.H.S., Maskoen, T.T., Putranto, T.A., Setiawan, E. 2019. Short insight of pediatric cerebral venous thrombosis and the safety of intra-arterial heparin flushing as a new therapeutic method. Bali Medical Journal 8(2): 469-473. DOI:10.15562/bmj.v8i2.1463 Short insight of pediatric cerebral venous thrombosis and the safety of intra-arterial heparin flushing as a new therapeutic method Ardianto Pramono, 1,2* Ristaniah Soetikno, 1 Achmad Hussein Sundawa Kartamihardja, 3 Tinni Trihartini Maskoen, 4 Terawan Agus Putranto, 2 Erwin Setiawan 1,2 INTRODUCTION Cerebral Venous Trombosis (CVT) described as a thrombosis of intracranial venous sinuses and cerebral veins, which can lead to disrupted venous drainage and can induce intracranial hypertension and venous infarcts. 1 Te cerebral venous system is a network of cortical, medullary, and deep veins from which the venous blood will drain into the dural venous sinuses. Trombosis in the cerebral venous system impedes venous outfow, resulting in increased central venous pressure, which in turn causes intracranial hypertension and leads to cere- bral ischemia, which may evolve to infarction or hemorrhage. 2,3 Most of the times, CVT cases can only be found in adult patients. According to a previous study by de Veber et al. in 2001, the incidence rate of CVT is at least 0.67 per 100.000 children per year. 4 Tis number showed us that CVT is not only a prob- lem present in adult patients but also for pediat- ric patients. CVT in pediatric patients generally underdiagnosed, but it is an important cause of stroke in childhood which occurs most frequently in the neonatal period. 5 However, when MRI (Magnetic Resonance Imaging) examination was performed on children who sufer from symptoms resembled an ASD (Autism Spectrum Disorder) such as poor concentration, repetitive movement and lack of communication, the results showed that there were signs of CVT. According to deVeber et al., Te signs & symptoms of CVT in pediatric patients may vary, but the most common clinical features are seizures, headache, respiratory distress, focal neurological defcits and even lead to coma- tose state. 6 Patients whose diagnosed with CVT may also present with defcits related to venous infarc- tion which ranging from developmental delays, learning disabilities, hemiparesis and hemisensory loss. 5 A study by Carvalho et al. even shows that pedi- atric patients who sufer from CVT afer a follow up around 22 months showed a developmental delay. 7 Te known mechanism of CVT signs and symp- toms can be divided into two, thrombosis of the cerebral veins and thrombosis of the major sinuses which both processes occur simultaneously. 1 1 Department of Radiology, Universitas Padjadjaran, Jatinangor, Sumedang, Indonesia. 2 Department of Interventional Radiology, RSPAD Gatot Soebroto Jakarta, Indonesia. 3 Department of Nuclear Medicine, Universitas Padjadjaran, Jatinangor, Sumedang, Indonesia. 4 Department of Anesthesiology and Intensive Care, Universitas Padjadjaran, Jatinangor, Sumedang, Indonesia. * Correspondence to: Ardianto Pramono. Department of Radiology, Universitas Padjadjaran. Jln. Raya Bandung-Sumedang, Jatinangor, Sumedang, Indonesia. humas@unpad.ac.id Received: 2019-02-05 Accepted: 2019-03-30 Published: 2019-08-01