Introduction Paediatric cerebral venous sinus thrombosis (CVST) is a rare condition (3 cases/million population), usually idiopathic. Traumatic head injury is a rare cause of this severe disease and no consensus exists regarding diagnosis and management of post-traumatic CVST. We describe the case of a patient with blunt head injury who developed sigmoid sinus and Internal Jugular Vein Thrombosis (IJVT), successfully treated with anticoagulation therapy (ACT).
Case-Report A 14 years old boy, previously healthy, was brought to our ED because of an head trauma and transient loss of consciousness after a road traffic accident. On arrival he was conscious and irritated and needed sedation and oro-tracheal intubation. Immediate CT showed right temporo-parietal fracture with left fronto-parietal subarachoid hematoma. A 48 h CT revealed a worsening of right temporal hematoma and an hyperdensity area at the right sigmoid sinus suggestive of CVST, confirmed by CT venography as venous thrombosis of sigmoid sinus and IJV. His coagulation profile was normal. The patient started immediately Low Molecular Weight Heparin therapy, continued for three months. The MRI after two weeks of ACT was normal. He was discharged after 27 days without any neurological deficit.
Conclusion Our report demonstrates importance of suspicion for CVST in head trauma, especially in those with high energy trauma or focal lesion, in which the neurological status cannot be monitored. The early diagnosis may permit to start an appropriated ACT, that is probably effective in reducing the risk of death and sequelae, if started early, during the acute phase.