PP10.8 – 2503: Sinus sagittalis superior thrombosis complicating moderate traumatic head injury in a child

Abstract

Objective Posttraumatic dural sinus thrombosis is a rare complication of traumatic head injury in children. Before the new anticoagulation guidelines (AHA/ASA 2011) the majority of patients were conservatively managed and their recoveries were mostly uneventful. However there are a few case reports where severe complications and even death occurred. According to the new guidelines pharmacological treatment of posttraumatic dural sinovenous thrombosis consists of administering low molecular weight heparin, (LMWH) or venous heparin. In situations, where systemic anticoagulation is contraindicated, local thrombolysis is allowed. Case report A 14 year old child suffered moderate traumatic head injury. Subgaleal and epidural hematomas were diagnosed on CT, and the suspicion of superior sagittal sinus thrombosis was raised. MR venography verified an incomplete superior sagittal sinus (SSS) thrombosis. Weighting the risk of progression of the thrombosis to further bleeding full dose LMWH was administered. Results The patient remained stable, but the hematomas started to grow. Neuroradiological counselling revealed suturolysis of the corona sutures on both sides, and fracture of the inner table of the skull at the sagittal superior suture on CT. A small epidural hematoma over the superior sagittal sinus was diagnosed, compressing the vein. The dose of LMWH was lowered to preventive dosage, and was administered for four month. On the follow up MRI examination the hematomas were absorbed, and the SSS recanalised. Conclusion Treating traumatic sinodural thrombosis in children with intra and extra cranial hematomas remains controversial. The decision in these situations must be individualized and during the clinical course frequently re-evaluated