Cerebral Venous Sinus Thrombosis in Closed Head Injury: Systematic Review and Meta-analysis

Post-Traumatic Cerebral Venous Sinus Thrombosis (PtCVST) Resulting in Increased Intracranial Pressure during Early Post-Traumatic Brain Injury Period: Case Report and Narrative Literature Review

Post-traumatic cerebral venous sinus thrombosis (ptCVST) often remains underdiagnosed due to the non-specific nature of clinical signs, commonly mimicking severe traumatic brain injury (TBI) manifestations. Early recognition of this rare and potentially life-threatening complication is crucial for the effective management of severe TBI patients in Intensive Care. The present study reports the case of a 66-year-old male who was transferred to the emergency department due to moderate TBI. Initial emergency brain computed tomography (CT) scans revealed certain traumatic lesions, not necessitating any urgent neurosurgical intervention. During his stay in an Intensive Care Unit (ICU), multiple transient episodes of intracranial pressure (ICP) values were managed conservatively, and through placement of an external ventricular drain. Following a series of CT scans, there was a continuous improvement of the initial traumatic hemorrhagic findings despite his worsening clinical condition. This paradox raised suspicion for ptCVST, and a brain CT venography (CTV) was carried out, which showed venous sinus thrombosis close to a concomitant skull fracture. Therapeutic anticoagulant treatment was administered. The patient was discharged with an excellent neurological status. To date, there are no clearly defined guidelines for medical and/or surgical management of patients presenting with ptCVST. Therapy is mainly based on intracranial hypertension control and the maintenance of normal cerebral perfusion pressure (CCP) in the ICU. The mismatch between clinical and imaging findings in patients with TBI and certain risk factors raises the suspicion of ptCVST.

Successful management of cerebral venous sinus thrombosis due to adenomyosis: Case reports and literature review

OBJECTIVES

Cerebral venous sinus thrombosis (CVST) due to adenomyosis, though rare, threaten women with severe morbidity. Adenomyosis is easily overlooked in the etiological assessment of CVST. Etiological under-recognization has considerable prognostic, and therapeutic implications. The current study reports two cases of successful management of cerebral venous sinus thrombosis due to adenomyosis.

MATERIALS AND METHODS

We present two young women with cerebral venous sinus thrombosis due to adenomyosis. We additionally review the literature to identify previously reported cases of stroke associated with adenomyosis.

RESULTS

Except for this report, a total of 25 cases of stroke related to adenomyosis have been reported in the literature, of which only three cases are related to CVST. Through their diagnosis and treatment, we believe that early diagnosis and treatment are important for these patients with long-term illnesses. In addition, through literature review, for female stroke patients with heavy menstruation combined with anemia or carbohydrate antigen (CA) 125 elevation, the existence of adenomyosis should be vigilant and the etiological treatment should be timely targeted.

CONCLUSION

Our cases illustrate the significance of the etiological identification of CVST for women with adenomyosis and serve to increase clinicians' awareness of this disabling, but sometimes treatable, condition. In CVST due to adenomyosis associated with iron deficiency anemia and/or high serum CA125 level, antithrombotic therapy and treatment for the anemia may improve the hypercoagulable state. The long-term monitoring of D-dimer levels is required.

Case Report of a 13-Year-Old Female With Trauma Secondary to a Fall From a Golf Cart, Found to Have Intraparenchymal & Subarachnoid Hemorrhages With Transverse Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is the occlusion of cerebral veins of the brain secondary to blood clot formation. These can result in increased intracranial pressure, cerebral edema, and may even have fatal consequences such as a stroke. Despite CVSTs being considered a rare pathology, these are said to have an increased incidence in the pediatric population. These individuals with CVST are often asymptomatic causing physicians to often overlook and delay possibly life-saving interventions. The current literature is lacking on CVST examples in the “older” range of the pediatric population, specifically teenagers. Here we present the case of a 13-year-old female with trauma secondary to a fall from a golf cart, who was found to have intraparenchymal and subarachnoid hemorrhages with transverse sinus thrombosis.