Occipital extradural hematoma simulating venous sinus thrombosis
Presentation
Car accident with head strike.
Patient Data
This case featured in our 2016 Trauma Radiology Course which is now available to view online.
Traumatic sulcal subarachnoid hemorrhage. Bilateral inferior and anterior temporal intraparenchymal hemorrhages. Squamous occipital bone fracture extending from the midline superiorly and down to the right inferiorly crossing the right transverse sinus. Small amount of hyperdensity is seen underlying a portion of the fracture in proximity to the dural sinus. Morphology suggests extradural hemorrhage rather than dural venous sinus thrombosis.
Study 3 days later reveals reduction in volume of traumatic subarachnoid blood and increased edema around the intraparenchymal hemorrhages. The CT venogram shows that the small right occipital extradural hemorrhage is displacing and thinning the transverse sinus at the torcula and right proximal transverse sinus without occlusion or thrombus formation.
Case Discussion
This case emphasizes the importance of not confusing extrinsic compression of a dural venous sinus by extradural hemorrhage with actual thrombus within the sinus. It is important to remember that skull fractures can be complicated by dural venous sinus thrombosis but one must be careful to distinguish thrombus within the vessel lumen itself from extrinsic compression. Overcalling thrombosis in the setting of trauma may lead to unnecessary anticoagulation and risk of hemorrhage from other sites of trauma.
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