Beyond the Concussion: Cerebral Venous Thrombosis Following Mild-to-Moderate Traumatic Brain Injury

Cerebral venous sinus thrombosis (CVST) accounts for a small proportion of strokes. Still, it carries meaningful clinical impact, classically linked to systemic prothrombotic conditions, hormonal influences, and severe traumatic brain injury (TBI). However, with advances in neuroimaging, it's now evident that trauma-related CVST (tCVST) can also complicate mild to moderate head injuries even in the absence of skull fractures. We report the case of a 31-year-old South Asian male who developed tCVST following a motorbike accident. He sustained a moderate TBI with a small occipital fracture. On presentation, he was confused (GCS 14/15), and initial imaging revealed small hemorrhagic cerebral contusions. Subsequent CT venography identified thrombus formation in the torcular Herophili, extending into the superior sagittal and transverse sinuses. Given the presence of hemorrhagic lesions, anticoagulation was withheld, and the patient was managed conservatively. He showed progressive clinical improvement, with follow-up imaging demonstrating partial recanalization by day 10. He was discharged neurologically intact on day 12. This case underscores the need for high clinical suspicion of CVST across the full spectrum of TBI severity. Its clinical features may be subtle and easily misattributed to primary traumatic pathology. Early recognition, particularly through CT or MR venography, is critical for timely diagnosis. Additionally, this case highlights the likelihood that CVST is underrecognized in patients with mild TBI, reinforcing the need for prospective studies to better define its true incidence, natural history, and optimal management strategies.