Traumatic dural sinus thrombosis causing persistent headache in a child

Abstract

Dural venous sinus thrombosis following a mild head injury is increasingly recognized. We report case of a 9-year-old male child presented with progressive headache and vomiting following a minor fall. A diagnosis of sinus venous thrombosis was suspected on nonenhancing computed tomography, and that was confirmed with magnetic resonance venography. The child was managed with intravenous fluids, anticoagulation (injection heparin followed by oral anticoagulants–tab coumarin), antiedema measures (mannitol), and antiepileptics (phenytoin) with good outcome.

Multiple cranial neuropathies in cerebral venous sinus thrombosis

“…Intracranial dural venous sinus thrombosis secondary to mild closed head injury without cranial vault fractures or intracranial hematomas is an increasingly recognized entity [ 4 ]. Bousser and Barnett [ 3 ] suggested separating CVST into the following four groups: those with isolated intracranial hypertension, with focal cerebral signs, with cavernous sinus syndrome and those with unusual presentations.…”

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

“…Development of cerebral venous sinus thrombosis (CVST) secondary to closed head injury with or without skull fractures or intracranial hematomas is being increasingly reported in the recent literature. [ 1 2 3 ] Venous sinus thrombosis has been shown to be one of the unsuspected causes of delayed intracerebral hemorrhage (ICH) following head trauma. [ 2 4 ] In view of enormous global burden of head trauma cases, particularly in the developing countries, few recognized cases perhaps represent the tip of the iceberg of this potentially treatable complication.…”

“…Various postulated hypotheses include skull fractures or intracranial hematomas causing thrombosis by direct compression of the sinus, endothelial injury within the sinus leading to the activation of the coagulation cascade, intramural hemorrhages due to rupture of small sinusoids, extension of the thrombus from injured emissary veins and compression of the sinuses from intracranial edema. [ 1 5 ]…”

“…Magnetic resonance (MR) imaging with MR venography (MRV) has nearly replaced by invasive cerebral angiography and conventional CT; however, CT venography is a reliable investigation and can be performed in the emergency settings without any additional delay when initial NCCT is equivocal or suggestive of venous thrombosis. [ 1 7 ]…”