Quadriplegia Following Depressed Skull Fracture Over Superior Sagittal Sinus: A Rare Presentation of a Common Event

Depressed skull fractures of the superior sagittal sinus (SSS) deserve special attention because they may lead to sinus obstruction or stenosis, resulting in venous hypertension. Here, we highlight an extremely unusual clinical presentation of a depressed skull fracture over the SSS obstructing the sinus, along with successful surgical management. A 35-year-old male patient presented with quadriplegia and intact sensations throughout the body following an alleged history of a rock falling on his head. On examination, computed tomography and magnetic resonance imaging of the brain revealed a depressed skull fracture over the SSS, with a filling defect in the SSS on magnetic resonance venography (MRV) underlying the fracture, along with venous hemorrhage and edema. The depressed fracture was elevated and managed postoperatively in the intensive care unit. At follow-up, the patient showed significant neurological improvement, and MRV demonstrated patent SSS. Radiological evidence of obstruction or thrombosis of the SSS, along with the corresponding neurological deficits in patients with midline depressed skull fractures, should be considered an indication for surgery.