Cerebral venous sinus thrombosis presenting as subdural haematoma

Abstract

The authors report a 39-year-old woman who presented with intermittent, excruciating nuchal and occipital headache. Magnetic resonance imaging and magnetic resonance angiography scans showed bilateral subdural haematomas with veno-occlusive disease of the superficial and deep venous systems. There were bridging collaterals with scalp veins, bleeds from which could explain the subdural haematoma. There was acute on chronic veno-occlusive disease with an acute rise in intracranial pressure and a bleed from the vein of Galen.

Does Intracranial Venous Thrombosis Cause Subdural Hemorrhage in the Pediatric Population?

“…15 Neither the previous mentioned case reports nor the autopsy series of Bailey and Hass described findings to support pre-existing elevated intracranial pressure. [4][5][6][7]14 Other clinical and imaging observations observed in conjunction with IVT include brain herniation syndromes, cerebral ischemia, or strokes that one might observe with acute states of intracranial hypertension, secondary to acute IVT, were also not described. [4][5][6][7]14,15 Therefore, in concordance with the literature, our study also does not support the correlation of IVT with SDH.…”

“…12,13 The theory that dural venous sinus thrombosis leads to increased pressure or tension in cortical veins and thus results in subdural bleeding was not observed in any patient in this retrospective study. [4][5][6][7]14 Our careful review of case reports that suggest IVT as an initiating event leading to SDH reveals that they barely satisfy the criteria for level III quality data, as established by the US Preventive Services Task Force. In fact, even in 1937, Bailey and Hass elegantly described 3 pediatric patients with IVT, 2 of whom had SDH at autopsy.…”

“…In 2005, Singh et al reported on a 39-year-old man with IVT and bifrontal hygromas. 7 No mention was made of antecedent trauma or whether the brain MR imaging evaluation included GRE imaging to assess for the presence of blood products.…”

“…6 Singh et al described a case of a 36-year-old woman presenting with SDH as a result of chronic cerebral vaso-occlusive disease. 7 Oral contraceptives are a known risk factor for IVT, as well as tumors, drugs, and pregnancy. Intracranial hemorrhage is described as a complication in adults with IVT but is often intraparenchymal in location and considered to be the result of hemorrhagic transformation of venous infarction.…”

“…The mechanism proposed is that IVT causes venous backpressure, leading to extravasation of blood into the subdural spaces. [4][5][6][7] Head trauma, however, is a well-recognized factor in the development of IVT, with direct damage to the venous sinuses. Complications of severe head trauma-such as sutural diastasis and/or skull fracture with mechanical compression or disruption of the venous sinus, shock, cerebral edema, poor cerebral perfusion, and coagulopathies-are also associated with the development IVT.…”