Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
World Neurosurg. 2021 Feb;146:274-276. doi: 10.1016/j.wneu.2020.11.084. Epub 2020 Nov 30.
Dural venous sinus thrombosis (DVST) after blunt head trauma is not rare; however, its clinical manifestations are vague, which impedes early diagnosis that is vital for its management. Prior studies have demonstrated that the presence of gas in the dural venous sinus (DVS) after blunt head trauma increases the likelihood of DVST. On nonenhanced computed tomography (CT), hyperdensity in the DVS is considered a direct sign of thrombosis, which can enable early diagnosis of traumatic DVST with high specificity but low sensitivity. We describe a case of traumatic DVST, which was diagnosed early based on the findings of gas and increasing density in the DVS on regular nonenhanced CT.
A 41-year-old man was admitted to our hospital after he landed on his head in a car accident. The initial CT (each slice 5.0 mm thick), taken 40 minutes after the injury, indicated right occipital skull fracture and gas in the right sigmoid sinus. Next, 16 hours after the injury, the patient underwent another head CT (each slice 1.25 mm thick). The image showed increasing density (>65 Hounsfield units) in the right sigmoid sinus and the area of intrasinus gas, which is an indication of traumatic DVST, and the bone window revealed right occipital skull fracture that extended to the right sigmoid sinus. Anticoagulant therapy was immediately started after subsequent computed tomographic venography confirmed nonocclusive venous thrombi in the right transverse sinus, the right sigmoid sinus, and the right internal jugular vein on the level of the second cervical vertebra. Three weeks after the injury, computed tomographic venography re-examination showed that the thrombi had resolved dramatically.
Traumatic DVST was diagnosed early through findings of gas and increasing density in DVS on different nonenhanced CTs. Finding this combination is a practical, sensitive method for early diagnosis of traumatic DVST, especially in patients with hidden skull fractures involving DVS and patients with hypocythemia.
钝性头部外伤后硬脑膜静脉窦血栓形成（DVST）并不少见；然而，其临床表现较为模糊，这阻碍了对其至关重要的管理的早期诊断。先前的研究表明，钝性头部外伤后硬脑膜静脉窦（DVS）中存在气体增加了 DVST 的可能性。在非增强 CT 上，DVS 中的高密度被认为是血栓形成的直接征象，这可以通过高特异性但低敏感性来实现对创伤性 DVST 的早期诊断。我们描述了一例创伤性 DVST 病例，该病例基于常规非增强 CT 上 DVS 中的气体和密度增加的发现而早期诊断。
一名 41 岁男性在车祸中头部着地后被送入我院。受伤后 40 分钟进行的初始 CT（每片 5.0 毫米厚）显示右侧枕骨颅骨骨折和右侧乙状窦气体。接下来，在受伤后 16 小时，患者接受了另一次头部 CT（每片 1.25 毫米厚）。图像显示右侧乙状窦和窦内气体区域的密度增加（>65 亨氏单位），这是创伤性 DVST 的指征，骨窗显示右侧枕骨颅骨骨折延伸至右侧乙状窦。随后的计算机断层血管造影术证实右侧横窦、右侧乙状窦和右侧颈 2 水平颈内静脉内非闭塞性静脉血栓形成后，立即开始抗凝治疗。受伤后 3 周，计算机断层血管造影复查显示血栓明显溶解。
通过不同非增强 CT 上 DVS 中气体和密度增加的发现，早期诊断创伤性 DVST。发现这种组合是一种实用、敏感的方法，可用于早期诊断创伤性 DVST，尤其是在 DVS 隐匿性颅骨骨折和低血容量的患者中。
