Cerebral venous sinus thrombosis in closed head trauma: A call to look beyond fractures and hematomas!

Ghuman, Mandeep S.; Salunke, Pravin; Sahoo, Sushanta K.; Kaur, Sukhminderjit

doi:10.4103/0974-2700.173865

Cited by 12 publications

(9 citation statements)

References 6 publications

(17 reference statements)

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“…Furthermore, progression or extension of clot is believed to contribute to accelerated intracranial pressure worsening and subsequent global venous outflow obstruction. 7,32 The rate of thrombus progression in tCVST has been reported between 0% and 4.3%. 9,33 A small case series found that 0 of 3 patients on AC demonstrated thrombus progression.…”

Section: Discussionmentioning

confidence: 99%

“…Blunt head trauma is a recognized risk factor for CVST, especially when a skull fracture is parallel to or crosses a dural venous sinus. 1-7 The incidence of traumatic CVST (tCVST) diagnosed on dedicated venous imaging after skull fractures is between 20% and 25%, 3,8,9 with mortality ranging between 5% and 11%. 8,10 Despite the rise in awareness and detection of tCVST, there is no formal consensus on effective treatment at this time.…”

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confidence: 99%

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Comparative Therapeutic Effectiveness of Anticoagulation and Conservative Management in Traumatic Cerebral Venous Sinus Thrombosis

et al. 2022

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BACKGROUND:Consensus is currently lacking in the optimal treatment for blunt traumatic cerebral venous sinus thrombosis (tCVST). Anticoagulation (AC) is used for treating spontaneous CVST, but its role in tCVST remains unclear.OBJECTIVE:To investigate the characteristics and outcomes of patients treated with AC compared with patients managed conservatively.METHODS:We retrospectively reviewed patients who presented to a Level 1 trauma center with acute skull fracture after blunt head trauma who underwent dedicated venous imaging.RESULTS:There were 137 of 424 patients (32.3%) presenting with skull fractures with tCVST on venous imaging. Among them, 82 (60%) were treated with AC while 55 (40%) were managed conservatively. Analysis of baseline characteristics demonstrated no significant difference in age, sex, admission Glasgow Coma Scale, admission Injury Severity Score, rates of associated intracranial hemorrhage, or neurosurgical interventions. New or worsening intracranial hemorrhage was seen in 7 patients treated with AC. Patients on AC had significantly lower mortality than non-AC (1% vs 15%; P = .003). There was no difference in the Glasgow Coma Scale or Glasgow Outcome Scale at last clinical follow-up. On follow-up venous imaging, patients treated with AC were more likely to experience full thrombus recanalization than non-AC (54% vs 32%; P = .012), and subsequent multiple regression analysis revealed that treatment with AC was a significant predictor of full thrombus recanalization (odds ratio, 5.18; CI, 1.60-16.81; P = .006).CONCLUSION:Treatment with AC for tCVST due to blunt head trauma may promote higher rates of complete thrombus recanalization when compared with conservative management.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Comparative Therapeutic Effectiveness of Anticoagulation and Conservative Management in Traumatic Cerebral Venous Sinus Thrombosis

et al. 2022

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“…The clinical presentation of CVT is often vague and largely depends on the site and extent of the lesion, age of onset, and Risk factors of cerebral venous thrombosis. [5,12, Prothrombotic states Infection (12%) [5,14,[26][27][28] Hereditary conditions (34-41%) [5,12,[14][15][16][17][18] 1. ENT and face infection (8.2-11%) 2.…”

Section: Clinical Presentationsmentioning

confidence: 99%

“…Protein C deficiency (2-5%) 6. Protein S deficiency (2-3%) Mechanical causes [5,12,[27][28][29][30] 1. Lumbar puncture (1.9%) 2.…”

Section: Clinical Presentationsmentioning

confidence: 99%

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Pathophysiology, diagnosis and management of cerebral venous thrombosis: A comprehensive review

Ranjan,

Ken-Dror,

Sharma

2023

Medicine

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Cerebral venous thrombosis is a rare cause of stroke in young mostly female adults which is frequently overlooked due to its variable clinical and radiological presentation. This review summarizes current knowledge on it risk factors, management and outcome in adults and highlights areas for future research. Females are 3 times more commonly affected and are significantly younger than males. The presenting symptoms can range from headache to loss of consciousness. However, the often-nebulous nature of symptoms can make the diagnosis challenging. Magnetic resonance imaging with venography is often the diagnostic imaging of choice. While unfractionated or low molecular-weight heparin is the mainstay of treatment, endovascular intervention with thrombolysis or thrombectomy and decompressive craniectomy may be required depending on clinical status. Nevertheless, approximately 80% of patients have a good recovery but mortality rates of −5% to 10% are not uncommon. Diagnosing cerebral venous thrombosis can be challenging but with vigilance and expert care patients have the best chance of a good clinical outcome.

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