Clinical characteristics, management, and outcomes of traumatic cerebral venous sinus thrombosis

BACKGROUND Traumatic cerebral venous sinus thrombosis (CVST) is abnormal clotting in one or more cerebral veins or sinuses following trauma. Its clinical significance is uncertain. Management is challenging because patients are at increased risk for bleeding. Limited studies exist on traumatic CVST. METHODS Retrospective cohort study of trauma patients admitted to a Level 1 trauma center between January 2014 and October 2023. Main objectives were to assess the following: (1) CVST prevalence, overall and according to head injury severity; (2) characteristics of trauma patients with CVST; and (3) management and outcomes of CVST patients. RESULTS On admission, all CVST patients (n = 170) had a traumatic brain injury (TBI) and an intracranial hemorrhage, and all except one had a skull fracture. Prevalence of CVST was 0.9% (95% confidence interval [CI], 0.8–1.0) in the overall trauma patient population (n = 18,569), 2.1% (95% CI, 1.9–2.5) in patients with TBI (n = 7,920), and 4.8% (95% CI, 4.0–5.8) in patients with severe TBI (modified head Abbreviated Injury Scale score, ≥4; n = 2,035). Twenty-eight patients with CVST died (16.5%), usually shortly after admission. The majority of patients (n = 100) with CVST were treated with standard venous thromboembolism (VTE) prophylactic dose of anticoagulant while in hospital. During median follow-up of 3 months, none of the patients treated with standard VTE prophylactic dose of anticoagulant developed a symptomatic CVST-related adverse event (death, stroke, intracranial hemorrhage). One patient (1.0%) had asymptomatic CVST-related stroke, three patients (3.0%) developed asymptomatic CVST extension, and 3 patients (3.0%) developed a gastrointestinal bleed on anticoagulant. CONCLUSION Traumatic CVST prevalence increases with head trauma severity and is unlikely to develop in the absence of skull fracture. Patients treated with standard VTE prophylactic doses of anticoagulants had favorable outcomes with minimal CVST-related complications during hospitalization. Longer-term data are needed to better evaluate traumatic CVST prognosis. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.