Traumatic Intracerebral Venous Thrombosis Associated With an Abnormal Golf Swing

Abstract

Objectives.-To describe the occurrence of cerebral venous thrombosis in a 40-year-old man whose cerebral event was induced by a poor golf swing, to review the literature on possible mechanisms producing venous thrombosis, and to compare this case with the literature.Background.-Headache is the most frequent symptom in patients with cerebral venous thrombosis. However, patients presenting with a headache due to cerebral venous thrombosis are uncommon. The known risk factors for thrombosis include both acquired and genetic factors. When the interaction of these two groups occurs, the magnitude of this interaction is thought to produce a dynamic state that can favor thrombosis. Our case report illustrates that moderate levels of anticardiolipin antibodies together with the mild trauma of a golf swing can induce a cerebral venous thrombosis. This case also suggests that although headache is rarely due to cerebral venous thrombosis, it should be excluded by good medical acumen and testing.Results.-Minor trauma induced by a poor golf swing was chronologically related to the development of a progressive cerebral venous thrombosis. The patient had none of the risk factors associated with a predisposition to venous thrombosis: hypercoagulable state, concurrent infection, pregnancy/puerperium, collagen vascular disorder, malignancy, migraine, false-positive VDRL, previous deep vein thrombosis, renal disease, factor V Leiden, or a hematological disorder. There was no anatomical abnormality that would predispose the patient to a cerebral venous thrombosis. The only laboratory abnormality was a moderate anticardiolipin antibody level (25 GPL). The patient was placed on warfarin sodium therapy and is currently without clinical sequela from the venous thrombotic event.Conclusions.-Under certain circumstances, minor trauma can induce cerebral venous thrombosis. A review of the literature indicates that cerebral venous thrombosis in the presence of anticardiolipin antibodies and in the absence of systemic lupus erythematosus is a rare event. Previously, only major traumatic events have been reported to be associated with cerebral venous thromboses. The chronological development of cerebral venous thrombosis after a faulty golf swing strongly indicates that given a background of moderate levels of anticardiolipin antibodies, even minor trauma can induce a venous thrombotic event.

Risk Factors of Cerebral Vein and Sinus Thrombosis

“…penetrating or close head injury [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74], neurosurgery [75,76], electrical injury [77,78], and lumbar puncture [79][80][81][82][83][84][85], have been linked to a higher risk of CVST.…”

“…In most cases, the transverse and sigmoid sinuses are involved. Thrombosis can occur in association with mild head injuries in the absence of fractures [54,68,74]. The exact mechanism is unknown, but may include compression of the sinuses due to intracranial edema or bleeding, intramural hemorrhages caused by rupture of small sinusoids, injury to the endothelial lining, changes in various components of the blood after head injury, and extension of the thrombus from abrasions of the scalp or injured emissary veins [57,72].…”

“…The exact mechanism is unknown, but may include compression of the sinuses due to intracranial edema or bleeding, intramural hemorrhages caused by rupture of small sinusoids, injury to the endothelial lining, changes in various components of the blood after head injury, and extension of the thrombus from abrasions of the scalp or injured emissary veins [57,72]. Some of these patients with mild head trauma have genetic or acquired thrombophilia, and the trauma may act as a trigger for thrombosis [61,67,68,72,73].…”

Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases

“…Headache as the only presentation of CVT in the absence of such conditions is rare. [5][6][7][8] In this paper we present the characteristics of 17 patientsfrom a prospective series of 123 patients with CVT seen over four years at our institution-in whom headache was the only clinical presentation of CVT in the absence of intracranial hypertension, SAH, meningitis, or other intracranial lesion as assessed by head CT and/or CSF examination.…”

Report of a recurrent cerebral venous thrombosis in a young athlete

“…Reports of venous thromboembolism occurring in athletes, especially with an intracranial location, are few and far between [2]. Furthermore, previous reports have been associated with thrombogenic factors like traumatism [3] or anabolic agent consumption [4]. We present the case of a young athlete who experienced two separate episodes of CVT, each occurring during intensive training for a triathlon.…”