Prevalence of Traumatic Dural Venous Sinus Thrombosis in High-Risk Acute Blunt Head Trauma Patients Evaluated with Multidetector CT Venography

Abstract

To determine the prevalence of trauma-related dural venous sinus thrombosis (DVST) in high-risk patients with blunt head trauma who are examined with multidetector computed tomographic (CT) venography. With institutional review board approval, HIPAA compliance, and waived informed consent, the authors retrospectively studied the findings in 195 consecutive patients who presented to the emergency department with acute blunt head trauma and were examined with multidetector CT venography because they were considered to be at high risk for DVST owing to the presence of a fracture near a dural venous sinus or jugular bulb or a high index of clinical suspicion. Nonenhanced CT images and CT venograms were reviewed for the presence of skull fractures, intracranial hemorrhage, and traumatic DVST. Magnetic resonance and nonenhanced CT images subsequently obtained in patients with traumatic DVST were assessed for hemorrhagic venous infarctions. Statistical analyses were performed by using Student t and Pearson chi(2) tests. Multidetector CT venography depicted thrombosis of 98 dural sinuses or jugular bulbs in 57 (40.7%) of the 140 patients with skull fractures extending to a dural sinus or jugular bulb. Fifty-four (55%) of the 98 sinuses or bulbs had occlusive thrombosis. DVST was seen in only those patients with skull fractures extending to a dural sinus or jugular bulb. Among the skull fractures extending to the transverse sinus, sigmoid sinus, or jugular bulb, those of the petrous temporal bone had a higher risk (50%, 36 of 72 fractures) of traumatic DVST than did those of the occipital bone (34% risk [32 of 93 fractures]) (P = .044). However, among the skull fractures extending to the superior sagittal sinus, those of the occipital bone had a higher risk (67% [eight of 12 fractures]) of traumatic DVST than did those of the parietal (39% risk [11 of 28 fractures]) and frontal (24% risk [four of 17 fractures]) bones (P = .065). Four (7%) patients with traumatic DVST had associated hemorrhagic venous infarctions, all secondary to occlusive DVST. In patients with blunt head trauma, multidetector CT venographic evaluation should be performed only if there is a fracture extending to a dural venous sinus or jugular bulb.