Trombosis de senos venosos cerebrales asociados al trauma encefalocraneano

Abstract

Introduction: Cerebral venous sinus thrombosis (CVST) presenting in patients with traumatic brain injury (TBI) is an apparently rare pathology, difficult to diagnose and controversial treatment. Objective: To analyze the incidence, clinical characteristics and evolution of patients admitted to an intensive care unit (ICU) with a diagnosis of TBI and who presented CSVT. Patients and Methods: Single-center retrospective study of all patients with moderate and severe TBI admitted to the ICU. Patients who underwent venous computed tomography angiography (CTA) were identified. Demographic and clinical characteristics, lesion patterns, CSVT treatment, and outcome at discharge from the unit were recorded. Results: 503 patients with moderate or severe TBI were admitted to the ICU. CTA was performed on 63 (12.5%). Of these, 22 were positive for CVST (34.9%). The incidence of CVST was 4.37% of all patients with TBI. The presence of any type of skull fracture was significantly associated with the presence of venous sinus thrombosis, mainly skull base and occipital bone fractures. 73% of the patients received anticoagulant treatment, with no associated bleeding complications being recorded. 59% of the patients had a good neurological outcome at discharge from the ICU. Conclusions: We analyze the first study on the subject reported in our environment. Skull fracture was significantly associated with the presence of thrombosis. A high index of suspicion and the application of a diagnostic tomographic algorithm are essential for the detection of CVST in patients with TBI. Anticoagulation appears to be a safe treatment in order to avoid serious complications associated with this clinical entity.