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Clinical characteristics, management, and outcomes of traumatic cerebral venous sinus thrombosis
Lior Kapitanski1, Kartiga Thiyagarajah, Ilia Makedonov
1From the Department of Medicine (L.K., W.G., R.F., J.-P.G.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto; Department of Hematology (K.T.), Niagara Health, St. Catharines; Department of Medicine (I.M.), Southlake Regional Health Centre, Newmarket, Department of Medical Imaging, Sunnybrook Health Sciences Centre (F.B.), Department of Medicine (J.A.), University Health Network, Department of Critical Care and Tory Trauma Program (M.C., R.F.), Division of Neurosurgery (L.d.C., F.P.), and Division of Neurology (C.H., S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; University Grenoble-Alpes (J.-L.B.), CNRS; Department of Public Health (J.-L.B.), Grenoble-Alpes University Hospital; and TIMC-IMAG (J.-L.B.), Grenoble, France.
Insights
Traumatic cerebral venous sinus thrombosis (CVST) is more common with severe head injuries and skull fractures. Standard anticoagulant doses showed favorable outcomes in hospitalized patients, warranting further long-term study.
Area of Science:
- Neurology
- Trauma Surgery
- Vascular Medicine
Background:
- Traumatic cerebral venous sinus thrombosis (CVST) is a rare condition following head trauma.
- Its clinical significance and optimal management remain unclear, particularly due to bleeding risks in trauma patients.
- Limited research exists on traumatic CVST, highlighting a need for further investigation.
Purpose of the Study:
- To determine the prevalence of traumatic CVST in trauma patients.
- To characterize patients with traumatic CVST.
- To evaluate the management and outcomes of traumatic CVST.
Main Methods:
- A retrospective cohort study was conducted at a Level 1 trauma center from January 2014 to October 2023.
- The study assessed CVST prevalence based on overall trauma, TBI, and severe TBI severity.
- Patient characteristics, management strategies, and outcomes were analyzed.
Main Results:
- CVST was diagnosed in 0.9% of trauma patients, with prevalence increasing with head injury severity (4.8% in severe TBI).
- All CVST patients had traumatic brain injury and intracranial hemorrhage; most had skull fractures.
- Anticoagulant prophylaxis in 100 patients resulted in no symptomatic CVST-related adverse events during hospitalization.
Conclusions:
- Traumatic CVST prevalence correlates with head trauma severity and is associated with skull fractures.
- Standard venous thromboembolism prophylactic anticoagulant doses appear safe and effective for hospitalized traumatic CVST patients.
- Longer-term follow-up data are necessary to fully understand the prognosis of traumatic CVST.
Background:
Traumatic cerebral venous sinus thrombosis (CVST) is abnormal clotting in one or more cerebral veins or sinuses following trauma. Its clinical significance is uncertain. Management is challenging because patients are at increased risk for bleeding. Limited studies exist on traumatic CVST.
Methods:
Retrospective cohort study of trauma patients admitted to a Level 1 trauma center between January 2014 and October 2023. Main objectives were to assess the following: (1) CVST prevalence, overall and according to head injury severity; (2) characteristics of trauma patients with CVST; and (3) management and outcomes of CVST patients.
Results:
On admission, all CVST patients (n = 170) had a traumatic brain injury (TBI) and an intracranial hemorrhage, and all except one had a skull fracture. Prevalence of CVST was 0.9% (95% confidence interval [CI], 0.8-1.0) in the overall trauma patient population (n = 18,569), 2.1% (95% CI, 1.9-2.5) in patients with TBI (n = 7,920), and 4.8% (95% CI, 4.0-5.8) in patients with severe TBI (modified head Abbreviated Injury Scale score, ≥4; n = 2,035). Twenty-eight patients with CVST died (16.5%), usually shortly after admission. The majority of patients (n = 100) with CVST were treated with standard venous thromboembolism (VTE) prophylactic dose of anticoagulant while in hospital. During median follow-up of 3 months, none of the patients treated with standard VTE prophylactic dose of anticoagulant developed a symptomatic CVST-related adverse event (death, stroke, intracranial hemorrhage). One patient (1.0%) had asymptomatic CVST-related stroke, three patients (3.0%) developed asymptomatic CVST extension, and 3 patients (3.0%) developed a gastrointestinal bleed on anticoagulant.
Conclusion:
Traumatic CVST prevalence increases with head trauma severity and is unlikely to develop in the absence of skull fracture. Patients treated with standard VTE prophylactic doses of anticoagulants had favorable outcomes with minimal CVST-related complications during hospitalization. Longer-term data are needed to better evaluate traumatic CVST prognosis.
Level Of Evidence:
Prognostic and Epidemiological; Level IV.
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