Intracranial Hypertension due to Cerebral Venous Sinus Thrombosis following Head Trauma: A Report of Two Cases
This patient was a 20-year-old male with a history of drug abuse. The patient had tried to commit suicide by jumping from the second floor of a building and landed on concrete. He was reported to have a Glasgow coma scale score of 9 on admission to hospital. A CT scan showed multiple non-dislocated fractures in the posterior fossa and cerebral contusions in the right cerebellar hemisphere and bifrontally (fig. ). The patient was intubated and transferred to the neurosurgical department at Umeå University Hospital. A clinical examination with a low dose of propofol revealed that he showed withdrawal to pain in all extremities and that the pupils were of normal size and reactive to light. An intraparenchymal pressure monitor was inserted (Codman MicroSensor; Johnson & Johnson) that showed an initial ICP of 50 mm Hg that soon increased to 80 mm Hg. A new CT scan showed only slight progress of contusions compared to the initial investigation. The patient was brought to the operating room, and a large bifrontal hemicraniectomy was performed. There was profuse venous bleeding from the bone and the dura during the procedure and there were clear signs of venous congestion of the cortical veins. At the end of the procedure, the ICP was approximately 25 mm Hg; however, it soon increased to 50 mm Hg. A new CT scan showed a substantial progress of cerebral oedema and frontal contusions, whereas a CT venography showed a thrombosed sigmoid sinus on the right side, a fractured jugular foramen and a thrombus extending down to the jugular vein (fig. ). The ICP further increased to 80 mm Hg and the patient subsequently died of circulatory arrest.\nWe received consent from the surviving patient in this case report. For obvious reasons, it was not possible to obtain such consent from the patient who died. There was no study protocol that needed approval from an ethical committee.