Cerebral venous pathology and paediatric head injury

Abstract

Cerebral venous thrombosis (CVT) is increasingly recognised in traumatic brain injury and carries a significant rate of complications leading to secondary brain insults. In general, the rate of complications is dependent on the anatomical location with midline and bilateral CVT associated with a significantly increased 30 day mortality in traumatic brain injury patients. Paediatric trauma related CVT is relatively uncommon (3%) and most cases of post-traumatic CVT in children involve a bone fracture along the adjacent dural sinus, but CVT can occur in the absence of a skull fracture. Older children are more likely to present with post-traumatic CVT and thrombosis occurs acutely, usually 1–5 days following head injury. Venous compromise may involve extrinsic sinus compression in addition to sinus thrombosis. Overlap in symptomology and descriptions of retinal and dural pathology associated with CVT has prompted some to advance CVT as a condition with a potential to mimic paediatric non-accidental head injury. CVT in the setting of NAHI is not uncommon (as much as a third of cases in the author’s experience). In this situation it though almost invariably represents a secondary, post-collapse complication due to venous stasis and a critically ill state with those rare cases showing evidence of CVT predating collapse typically associated with evidence of historic abusive injury. Careful scrutiny of the relevant scientific literature and due attention to clinicopathological features associated with CVT serve to further undermine CVT as a plausible alternative explanation for classic NAHI eye and intracranial pathology.