A Prospective Cohort Study Characterizing Incidence of Dural Venous Sinus Thrombosis in Traumatic Brain Injury Patients with Skull Fractures

BACKGROUND

Limited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with significant morbidity and mortality. Prospective data accurately characterizing the incidence of DVST in patients with high-risk TBI are sparse but are needed to develop evidence-based TBI management guidelines.

METHODS

After obtaining institutional approval, 36 adult patients with TBI with skull fractures admitted to an Australian level III adult intensive care unit between April 2022 and January 2023 were prospectively recruited and underwent computed tomography venography or magnetic resonance venography within 72 hours of injury. When available, daily maximum intracranial pressure was recorded.

RESULTS

Dural venous sinus abnormality was common (36.1%, 95% confidence interval 22.5%-52.4%) and strongly associated with DVST (P = 0.003). The incidence of DVST was 13.9% (95% confidence interval 6.1%-28.7%), which was lower than incidence reported in previous retrospective studies. Of DVSTs confirmed by computed tomography venography, 80% occurred in patients with extensive skull fractures including temporal or parietal bone fractures in conjunction with occipital bone fractures (P = 0.006). However, dural venous sinus abnormality and DVST were not associated with an increase in maximum daily intracranial pressure within the first 7 days after injury.

CONCLUSIONS

Dural venous sinus abnormality was common in TBI patients with skull fractures requiring intensive care unit admission. DVST was confirmed in more than one third of these patients, especially patients with concomitant temporal or parietal and occipital bone fractures. Computed tomography venography is recommended for this subgroup of TBI patients.

The effects of high dose sporadic (binge) alcohol intake in mice

BALB/c and CBA/h mice were used to investigate the teratogenic effects of sporadic high doses of ethanol. Two consecutive days between days 8 and 11 of organogenesis were chosen on which to administer 0.5 ml of 20 percent ethanol by gavage. An additional group was similarly dosed for four consecutive days starting on the eighth day. All the mice were killed on day 18 of gestation and evidence of growth retardation and malformation in the offspring was sought by skeletal and soft tissue screening. The basic pharmacokinetics of ethanol intake were also investigated. The most marked effects of ethanol were an increase in resorptions, skeletal growth retardation and skeletal variants, however all appeared to be strain specific. The results confirm that ethanol is embryotoxic and suggest that animal models are appropriate for studying aspects of growth retardation.