Prolonged barbiturate therapy in a patient with closed head injury and jugular venous thrombosis

The case of a patient who sustained a severe closed head injury complicated by jugular venous thrombosis is presented. Early problems with intracranial pressure were related to bifrontal intracerebral contusions. Jugular vein thrombosis became manifest clinically late in the patient's course and was verified by Doppler ultrasonography. Late problems with intracranial hypertension were presumed to be due to decreased cerebral outflow secondary to the thrombosis. The patient required 4 weeks of a high-dose regimen of pentobarbital to control his intracranial pressure. This is an exceptionally long period of time for a patient to be in barbiturate coma for a closed head injury and still make a satisfactory recovery. The incidence, etiology, prevention, and treatment of upper extremity and jugular venous thrombosis are discussed. The ramifications of jugular venous thrombosis in neurosurgical patients are discussed.