Post-Traumatic Cerebral Sinus Thrombosis: A Diagnostic and Therapeutic Challenge in the Emergency Department

Abstract

Post-traumatic cerebral sinus thrombosis (ptCST) is a rare but potentially life-threatening complication of head trauma, accounting for approximately 1% of all cerebral venous thrombosis cases and occurring in around 4% of patients sustaining traumatic brain injury [1,8]. The risk is significantly higher when a skull fracture extends to a dural sinus. We report the case of a 62-year-old male who presented following isolated blunt head trauma and was initially found to have a subarachnoid hemorrhage, a left frontal contusion, and a non-displaced occipital fracture extending to the right sigmoid sinus. Despite initial neurological stability, clinical deterioration occurred within 24 hours, characterized by signs of intracranial hypertension. Contrast-enhanced CT and brain MRI confirmed thrombosis of the right sigmoid sinus [5,6]. Management included symptomatic treatment, corticosteroids, and close neurological monitoring, with anticoagulation deferred given the hemorrhagic risk [2,9]. Favorable clinical evolution was observed at one week. This case highlights the diagnostic difficulty of ptCST, whose clinical presentation is non-specific, the key role of contrast-enhanced neuroimaging in diagnosis, and the ongoing therapeutic challenge posed by the competing risks of thrombosis extension and hemorrhagic complications of anticoagulation [11].