Occipital extradural haematoma simulating venous sinus thrombosis

Case contributed by Dr Andrew Dixon

Presentation

Car accident with head strike.

Patient Data

Age: 40
Gender: Male

This case featured in our 2016 Trauma Radiology Course which is now available to view online.

Traumatic sulcal subarachnoid haemorrhage. Bilateral inferior and anterior temporal intraparenchymal haemorrhages. 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 haemorrhage rather than dural venous sinus thrombosis. 

Study 3 days later reveals reduction in volume of traumatic subarachnoid blood and increased oedema around the intraparenchymal haemorrhages. The CT venogram shows that the small right occipital extradural haemorrhage 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 haemorrhage 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 haemorrhage from other sites of trauma.

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Case Information

rID: 46514
Case created: 6th Jul 2016
Last edited: 28th Jul 2016
System: Trauma
Inclusion in quiz mode: Included

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