Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review

Abstract

Background:Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH).Case Description:Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to the neurointensive care unit. A 38-year-old woman had both SDH and a hemorrhagic venous infarct associated with a transverse sinus thrombosis. She was managed conservatively with long-term anticoagulation. A 68-year-old woman presented with an acute SDH requiring craniotomy and a thrombosed cortical vein was noted intraoperatively. Computed tomography venography showed thrombosis of the superior sagittal sinus. She had polycythemia vera with the V617 Jak2 gene mutation and was managed with aspirin and hydroxyurea. A 60-year-old male had recurrence of a spontaneous convexity SDH requiring reoperation. Neuroimaging identified ipsilateral transverse sinus thrombosis with retrograde flow into the opposite sinus. Manometry demonstrated elevated venous pressures and these normalized after thrombectomy. Angiography performed after endovascular treatment demonstrated a normal venous drainage pattern. There have been limited reports of SDH complicating CVST in the literature.Conclusion:This case series and literature review demonstrates that CVST can also present with spontaneous SDH with or without associated venous infarctions. Treatment must be individualized. This is the first published description of endovascular thrombectomy for recurrent symptomatic SDH due to CVST.

Spontaneous subdural hematoma associated to Duret hemorrhage

“…Studies show that 11% of all CVTs might be related to malignancy [13]. Nevertheless, CVT has only rarely been associated to SH [14], both of which are usually caused by intracranial hypotension, not fit for our patient presentation. Likewise, isolated SH is a rare presentation of AVM or aneurism [15,16].…”

Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis

“…It is well known that venous hypertension can cause cortical ischemia and hemorrhage [16]. In 2013 Akins et al [17] reported on 3 cases of cerebral venous sinus thrombosis causing subdural hematoma and found 6 further cases published in the literature. It is possible that the etiology of the cSDH could be slow bleeding from engorged congested cortical veins [17].…”

“…In 2013 Akins et al [17] reported on 3 cases of cerebral venous sinus thrombosis causing subdural hematoma and found 6 further cases published in the literature. It is possible that the etiology of the cSDH could be slow bleeding from engorged congested cortical veins [17]. This could also help to explain the bilateral convexity distribution.…”

Alternate theories of causation in abusive head trauma: What the science tells us

“…In rare cases this has been reported in adults with severe underlying illnesses [24][25][26][27][28]. Newborn infants are known to be more susceptible to venous sinus thrombosis and often are found to have coexisting subdural hematoma, as well [29].…”