Lateral sinus thrombosis: complication of minor head injury

Our review aims: (1) to highlight the suspicion of lateral sinus thrombosis (LST) following a minor head injury in the pediatric population; (2) to discuss the different etiologies of lateral sinus thrombosis; (3) to identify an exact mechanism of the thrombus formation; (4) to clarify the role of each diagnostic tool; (5) to implement an algorithm for the treatment of LST due to a minor head injury.

We performed a MEDLINE search for LST following a minor head trauma related articles that were published between 1950 and June 2008. We identified 19 related studies of which 22 patient records were noted. We also added our case to this series. The information from the reports was analyzed to characterize the clinical aspects, the radiologic findings, the treatment, the follow-up, and the management of this disease.

Twenty-three cases (20 pediatrics and 3 adults) of LST following a minor head trauma have been published including the new one presented here. The mean pediatric age in this series is 7.8 years. There were 11 cases on the right side and 8 on the left side. Male to female ratio is 1.4:1. Side and sex were not reported in 4 and 6 cases, respectively. Sigmoid and transverse sinuses were the most affected one. Eighty-three percent were treated by observation while the remaining 17% received anticoagulation. The outcome was good in all patients without any notable major complications. The radiological investigation showed that there was a complete recanalization in 9 patients and a partial recanalization in 3 patients with a mean time of 8.3 weeks.

Lateral sinus thrombosis seldomly occurs following a minor head injury. This entity is difficult to diagnose and one should exercise a high degree of suspicion when confronted with an ambiguous neurological status following a closed head trauma. The most accurate imaging test according to our experience is a multiple detector row computerized tomography (MDCT) venography completed at the time of the presentation. The indication to proceed with an MRI has to be assessed on a case-by-case basis. Anticoagulation is reserved for patients presenting a papilledema or for patients complaining of persistent headaches, vomiting, or disequilibrium.