Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Neurosurgery. 2011 Jun;68(6):E1756-60; discussion E1760. doi: 10.1227/NEU.0b013e3182171439.
Pulmonary embolus (PE) occurring concurrent with-and as a result of-traumatic superior sagittal sinus thrombosis (SSST) has never before been reported. We report the first case of a patient who presented with acute traumatic SSST and concomitant PE.
A 30-year-old man presented with altered mental status after a motorcycle collision, and subsequently developed respiratory distress. Computed tomography (CT) scanning of the head revealed multiple calvarial and skull base fractures, contusions, and hemorrhages. Air was noted within the superior sagittal sinus, indicating a fracture involving the sinus and suggesting thrombus formation. A chest CT scan obtained at the time of presentation revealed a PE in the right pulmonary artery. The patient had no personal or family history of hypercoagulability, and all coagulation study results were within normal limits. Work-up revealed no evidence of long bone fractures or deep venous thrombosis. Initial intervention involved placement of an external ventricular drain, brain tissue oxygen saturation probe, internal jugular venous oxygen saturation monitor, arterial line, and central venous line with extensive treatment of all abnormal values according to established standards. Ultimately, pentobarbital coma was initiated for persistently elevated intracranial pressure (ICP) refractory to conservative measures. Aggressive pulmonary resuscitation was required to maintain adequate oxygenation. Anticoagulation was begun 3 weeks after admission.
Our patient had good neurological recovery. This report highlights the possibility of acute PE in the setting of traumatic SSST.
外伤性上矢状窦血栓形成（SSST）并发肺动脉栓塞（PE）此前尚未有报道。我们报告首例同时发生急性外伤性 SSST 和 PE 的患者病例。
一名 30 岁男性因摩托车事故导致意识改变，随后出现呼吸窘迫。头颅 CT 扫描显示多发颅骨和颅底骨折、挫伤和出血。上矢状窦内可见气影，提示窦壁骨折并伴有血栓形成。患者就诊时的胸部 CT 扫描显示右侧肺动脉 PE。该患者无个人或家族高凝血症史，所有凝血研究结果均在正常范围内。检查未发现长骨骨折或深静脉血栓形成。初始干预措施包括放置外部脑室引流管、脑组织氧饱和度探头、颈内静脉氧饱和度监测仪、动脉置管和中心静脉置管，并根据既定标准广泛治疗所有异常值。最终，由于持续升高的颅内压（ICP）对保守治疗无反应，开始使用戊巴比妥昏迷疗法。需要进行积极的肺复苏以维持足够的氧合。入院后 3 周开始抗凝治疗。
我们的患者有良好的神经恢复。本报告强调了外伤性 SSST 时发生急性 PE 的可能性。
