Post-Traumatic Cerebral Venous Sinus Thrombosis (PtCVST) Resulting in Increased Intracranial Pressure during Early Post-Traumatic Brain Injury Period: Case Report and Narrative Literature Review

Autor: Athanasios Theofanopoulos, Athanasia Proklou, Marianna Miliaraki, Ioannis Konstantinou, Konstantinos Ntotsikas, Nikolaos Moustakis, Sofia Lazarioti, Eleftherios Papadakis, George Kypraios, Georgios Angelidis, Georgia Vaki, Eumorfia Kondili, Christos Tsitsipanis
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Healthcare, Vol 12, Iss 17, p 1743 (2024)
Druh dokumentu: article
ISSN: 12171743
2227-9032
DOI: 10.3390/healthcare12171743
Popis: Post-traumatic cerebral venous sinus thrombosis (ptCVST) often remains underdiagnosed due to the non-specific nature of clinical signs, commonly mimicking severe traumatic brain injury (TBI) manifestations. Early recognition of this rare and potentially life-threatening complication is crucial for the effective management of severe TBI patients in Intensive Care. The present study reports the case of a 66-year-old male who was transferred to the emergency department due to moderate TBI. Initial emergency brain computed tomography (CT) scans revealed certain traumatic lesions, not necessitating any urgent neurosurgical intervention. During his stay in an Intensive Care Unit (ICU), multiple transient episodes of intracranial pressure (ICP) values were managed conservatively, and through placement of an external ventricular drain. Following a series of CT scans, there was a continuous improvement of the initial traumatic hemorrhagic findings despite his worsening clinical condition. This paradox raised suspicion for ptCVST, and a brain CT venography (CTV) was carried out, which showed venous sinus thrombosis close to a concomitant skull fracture. Therapeutic anticoagulant treatment was administered. The patient was discharged with an excellent neurological status. To date, there are no clearly defined guidelines for medical and/or surgical management of patients presenting with ptCVST. Therapy is mainly based on intracranial hypertension control and the maintenance of normal cerebral perfusion pressure (CCP) in the ICU. The mismatch between clinical and imaging findings in patients with TBI and certain risk factors raises the suspicion of ptCVST.
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