Cerebral Venous Thrombosis in Patients With Traumatic Brain Injury: Epidemiology and Outcome

Joao Meira Goncalves; Vasco Carvalho; António Cerejo; Patricia Polónia; Elisabete Monteiro

doi:10.7759/cureus.55775

Cerebral Venous Thrombosis in Patients With Traumatic Brain Injury: Epidemiology and Outcome

Cureus. 2024 Mar 8;16(3):e55775. doi: 10.7759/cureus.55775. eCollection 2024 Mar.

Authors

Joao Meira Goncalves^{1

2}, Vasco Carvalho^{1

2}, António Cerejo^{1

2}, Patricia Polónia^{1

2}, Elisabete Monteiro³

Affiliations

¹ Neurosurgery Department, Centro Hospitalar Universitário de São João, Porto, PRT.
² Faculty of Medicine, Oporto University, Oporto, PRT.
³ Intensive Care Medicine Department, Centro Hospitalar Universitário de São João, Porto, PRT.

Abstract

The natural history and epidemiological aspects of traumatic cerebral venous thrombosis (CVT) are not fully understood. Due to the concomitant occurrence with intracranial hemorrhages, guidelines for medical treatment have been highly controversial. In this study, our objective was to carry out an analysis description of the population and to conduct a literature review. A prospectively gathered radiology registry data of patients hospitalized at the tertiary hospital of Centro Hospitalar Universitário do São João, Porto, Portugal, between 2016 and 2021 was carried out. All patients with traumatic brain injury (TBI) and concomitant CVT were identified. CVT was confirmed by CT venogram. Demographic, clinical, and radiological data and their medical management were reported. In-hospital complications and treatment outcomes were compared between patients measured by the Glasgow Outcome Score Extended (GOSE) at discharge and GOSE at three months. There were 41 patients with traumatic CVT admitted to this study. The majority (45.2%) had a hyperdense signal near the lateral sinus at admission, and only 26.2% presented with skull fractures. Of this cohort, 95% had experienced lateral sinus thrombosis. Twenty-five patients (60%) had occlusive venous thrombosis. Venous infarct was the main complication following CVT. Thirty-two patients (78%) were anticoagulated after CVT and four developed complications. At the three-month follow-up after discharge, 28.2% had good recovery (GOSE > 6). This study revealed a higher incidence of CVT in severe TBI and a mild association with skull fractures. There is a higher incidence of CVT in the lateral sinus. Management was inconsistent, with no difference in outcome without or with anticoagulation. Larger, prospective cohort studies are required to better comprehend this condition and determine evidence-based guidelines.

Keywords: cerebral venous infarction; cerebral venous thrombosis (cvt); secondary intracranial hypertension; therapeutic anticoagulation; traumatic brain injury(tbi).