Characterization of acute traumatic cerebral venous sinus thrombosis (P5.9-055)

Objective: To describe the clinical characteristics of traumatic venous sinus thrombosis patients seen in an urban level 1 trauma center. Background: Traumatic cerebral venous sinus thrombosis (tCVST), a rare neurovascular entity, is increasingly detected on neuroimaging and is frequently seen in association with skull fracture. Because of its co-occurrence with intracranial hemorrhage, guidelines for medical management have been highly controversial. As part of an observational study of tCVST in patients hospitalized with acute traumatic injuries, we sought to study the occurrence and clinical course of tCVST. Design/Methods: Electronic radiology reports from 2015 to 2018 were queried to identify patients who had an acute trauma series of head CT/CTV or MRI/MRV brain using the search phrase “venous sinus thrombosis”. Cases having reports with a description of tCVST were extracted and reviewed. Results: Among 265 unique records identified, 18 patients were confirmed to have had radiologic diagnosis of tCVST. Mean age was 42.1 (SD=20.4) years. Over half (12/18=66.7%) were diagnosed within 1 day of admission, with average admission GCS=11.8 (SD=3.7). Skull fractures were common, 83.3% (15/18) with temporal fractures being most common (11/15) and most associated with transverse (8/11) and sigmoid (7/11) tCVST. 16 of 18 also suffered intracranial hemorrhage including subdural, intraparenchymal and epidural hemorrhage. The most common neurologic deficit was reduced level of consciousness, 8 of 18. The most common location of tCVST was sigmoid (12/18) and transverse (12/18) sinus, followed by jugular bulb (6/18). Most patients were initiated on antithrombotic therapy (9/18) as an inpatient including aspirin (8/9), low molecular weight heparin (1/9) and warfarin (1/9). Conclusions: The sigmoid and transverse sinuses are potentially vulnerable locations for tCVST. More research is needed to guide medical management of this complex syndrome. Disclosure: Dr. Schwartz has nothing to disclose. Dr. Talbott has nothing to disclose. Dr. Ch’ang has nothing to disclose. Dr. Singh has nothing to disclose.