Venous Sinus Thrombosis in Blunt Trauma: Incidence and Risk Factors

Abstract

Dural venous sinus thrombosis in the setting of blunt trauma with a calvarial fracture crossing a dural venous sinus has an incidence of 23%. Increased suspicion for thrombosis is warranted in patients with temporal or skull base fractures, low GCS score, and recent fall from great height.

Traumatic dural venous sinus gas predicts a higher likelihood of dural venous sinus thrombosis following blunt head trauma

“…We show a strong association between skull fractures extending to a dural venous sinus and sinus thrombosis. A high prevalence (33.3%) of thrombosis was found in the sinuses involved by skull fractures, comparable to previously published prevalences of 23–40.7% . As with other series, traumatic DVST was uncommon in the absence of a fracture, only observed in 2 (9.5%) of 21 patients.…”

“…Prior studies have established skull fractures as a risk factor for DVST, [9][10][11]17,26 and the results from our study support this. We show a strong association between skull fractures extending to a dural venous sinus and sinus thrombosis.…”

“…A high prevalence (33.3%) of thrombosis was found in the sinuses involved by skull fractures, comparable to previously published prevalences of 23-40.7%. 6,9,10,17 As with other series, 9,27 traumatic DVST was uncommon in the absence of a fracture, only observed in 2 (9.5%) of 21 patients. Evaluation of fracture location suggests an increased risk of thrombosis in fractures involving the sigmoid sinus.…”

“…Currently, non‐enhanced CT remains the first line investigation for blunt head trauma in most emergency settings . Skull fractures overlying a dural venous sinus and increased sinus density on non‐enhanced CT have been associated with DVST …”

“…7,8 Skull fractures overlying a dural venous sinus and increased sinus density on non-enhanced CT have been associated with DVST. [9][10][11][12][13][14][15][16][17] It has not been investigated whether patients with intraluminal sinus gas may have a higher likelihood of DVST in the setting of trauma. Intrasinus gas has been noted in prior case reports [18][19][20][21][22][23] and we postulate that it may be a marker of sinus injury, suggesting an increased risk of sinus thrombosis.…”