J Korean Neurosurg Soc.  2015 Aug;58(2):150-154. 10.3340/jkns.2015.58.2.150.

Early Spontaneous Recanalization of Sigmoid Sinus Thrombosis Following a Closed Head Injury in a Pediatric Patient : A Case Report and Review of Literature

• Yun JH
• Ko JH
• Lee MJ

• KMID: 2191326
• DOI: http://doi.org/10.3340/jkns.2015.58.2.150

Abstract

Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.

Keyword

Head trauma; Sigmoid sinus thrombosis; Pediatric; Recanalization

MeSH Terms

Brain
Child
Colon, Sigmoid*
Craniocerebral Trauma
Diagnosis
Head Injuries, Closed*
Headache
Hematoma
Humans
Jugular Veins
Magnetic Resonance Imaging
Male
Nausea
Phlebography
Pneumocephalus
Sinus Thrombosis, Intracranial*
Skull
Vomiting

Figure

• 

  Fig. 1 Brain computed tomography (CT) showed a linear fracture in the right occipital bone (A) and a suspicious intracranial hematoma (B, white arrow) with pneumocephalus (C) around the fracture site. Additionally, a high-density lesion located in right sigmoid sinus was revealed (D, black arrow, "dense vein sign").

• 

  Fig. 2 In contrast with left side, the thrombus in the right sigmoid sinus demonstrated low signal intensity in a T2-weighted image (A, black arrow) and iso-signal intensity in a T1-weighted image (B, white arrow) on brain magnetic resonance image (MRI).

• 

  Fig. 3 A : Initial brain magnetic resonance venography (MRV) demonstrated a loss of the flow signal from the right sigmoid sinus to the distal (white arrow). B : After about three weeks, a follow-up brain MRV demonstrated a recanalization of the sinus, which was a recovery of the signal from the right sigmoid sinus to the distal jugular vein.

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