Presentation
Found collapsed at party. Uncertain history of trauma. GCS 6 at scene, and now improved but postictal with confusion and vomiting. Large boggy occipital hematoma.
Patient Data
Initial unenhanced CT, with recall for CTA and CTV phases.
Linear left posterior parietal fracture, extending into the occipital sutures, with diastasis of the right occipital suture.
Faint peripheral traumatic subarachnoid blood over the right cerebral sulci, with trace surface blood products in the middle cranial fossa.
Hyperdensity immediately deep to the disrupted right occipital suture on the unenhanced study.
No significant abnormality on the CTA (i.e. no aneurysmal cause for peripheral SAH).
CTV demonstrates elevation of the posterior part of the superior sagittal sinus, torcula and right transverse sinus. This is extrinsic to the venous sinus and corresponds with the mixed density on the unenhanced phase. This is not a traumatic venous sinus thrombosis, but instead a shallow extradural hematoma - likely with some venous bleeding - which is elevating the venous sinuses.
Findings as above. DICOM imaging for future use.
Case Discussion
This trauma case is a good example of the use of CTV - especially when there are fractures or sutural diastases this might disrupt the venous sinuses. This blood accumulates in the epidural space, but differ from arterial (e.g. MMA) extradural hematomas in terms of the clinical presentation. Another location which can get similar venous extradural hematomas are the middle cranial fossa poles - with disruption of the sphenoparietal sinus.
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