Jonathan Wilcher1, Michelle Pannell. 1. From the Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS.
Abstract
OBJECTIVE: Closed head injury rarely predisposes patients, particularly children, to the development of dural sinus thrombosis. In addition, most cases of sinus thrombosis are subacute in nature. The following is a case report of a precipitous course of dural sinus thrombosis after closed head injury in a pediatric trauma patient. DESCRIPTION: A 14-year-old African American girl presented to the emergency department as a trauma activation. She was an unrestrained rear-seat passenger involved in a motor vehicle collision during which she was ejected. She experienced loss of consciousness and was found unresponsive at the scene. She was intubated and then transported via helicopter to the level I trauma center. Initial head computed tomography (CT) revealed no acute intracranial abnormality. The head CT was repeated 15 hours later when nursing noted the patient to be acutely hypertensive and tachycardic with an 8-mm nonreactive right pupil. The repeated CT showed interval development of extensive dural sinus thrombosis, cerebellar edema and infarct, as well as mild downward transtentorial herniation. Because of multiple coexistent injuries and complications, treatment of the dural sinus thrombosis was difficult. The hospital course was complicated and there was very little improvement in the patient's condition. CONCLUSIONS: The multisystem injured trauma patient poses many clinical challenges. Treatment of dural sinus thrombosis is difficult and controversial and requires an investigation into possible risk factors for a hypercoagulable state. Clinical outcomes vary from excellent to dismal.
OBJECTIVE: Closed head injury rarely predisposes patients, particularly children, to the development of dural sinus thrombosis. In addition, most cases of sinus thrombosis are subacute in nature. The following is a case report of a precipitous course of dural sinus thrombosis after closed head injury in a pediatric traumapatient. DESCRIPTION: A 14-year-old African American girl presented to the emergency department as a trauma activation. She was an unrestrained rear-seat passenger involved in a motor vehicle collision during which she was ejected. She experienced loss of consciousness and was found unresponsive at the scene. She was intubated and then transported via helicopter to the level I trauma center. Initial head computed tomography (CT) revealed no acute intracranial abnormality. The head CT was repeated 15 hours later when nursing noted the patient to be acutely hypertensive and tachycardic with an 8-mm nonreactive right pupil. The repeated CT showed interval development of extensive dural sinus thrombosis, cerebellar edema and infarct, as well as mild downward transtentorial herniation. Because of multiple coexistent injuries and complications, treatment of the dural sinus thrombosis was difficult. The hospital course was complicated and there was very little improvement in the patient's condition. CONCLUSIONS: The multisystem injured traumapatient poses many clinical challenges. Treatment of dural sinus thrombosis is difficult and controversial and requires an investigation into possible risk factors for a hypercoagulable state. Clinical outcomes vary from excellent to dismal.