Presentation
Fall from bike.
Patient Data
Thin scalp hematoma overlying the left lambdoid suture. Contracoup right frontal and temporal intraparenchymal hemorrhages and trace adjacent extra-axial hemorrhage. A single locule of gas is seen within the left transverse sinus and there is hyperdensity of the left sigmoid sinus suspicious for acute thrombosis. There is subtle diastasis of the left lambdoid suture and small volume fluid within the left mastoid air cells.
CT venogram confirms filling defect within the distal left transverse sinus extending into the sigmoid sinus in keeping with dural venous sinus thrombosis.
Case Discussion
This case emphasizes the importance of looking for signs of dural venous sinus thrombosis on trauma CT brain. Skull fracture crossing a suture (or suture diastasis) is the major risk factor for thombosis. It has also been proposed that intra-sinus gas (likely created by traumatic vacuum phenomenon) in the setting of fracture further increases the risk of thrombosis. Hyperdensity of the thrombosed segment on non-contrast CT is also a common and important feature.
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