Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Sign up to receive an email alert when a new Case of the Week is posted.
June 2, 2022
Dural Venous Sinus Laceration Complicating Extradural Hematoma
- Background:
- Dural venous sinus tears secondary to head trauma can occur in up to 1–4% of the population.
- This is associated with venous extradural hemorrhage and concurrent compression +/- thrombosis of the dural sinus, which can have significant mortality rates.
- Linear skull fractures parallel to the dural sinus are at high risk for massive bleeding.
- Clinical Presentation:
-
Patients will have a history of head trauma and possible loss of consciousness.
-
Mental status may initially be normal, although it will usually fluctuate and deteriorate.
-
Symptoms can include headache with external signs of trauma such as subgaleal hematoma or depressed skull fracture.
-
- Key Diagnostic Features:
- Skull fracture through a region where there is an underlying dural venous sinus
- On noncontrast CT, focal hyperattenuation adjacent to the dural sinus should raise the suspicion of a dural tear.
- Active extravasation from the dural sinus on venous phase contrast-enhanced imaging confirms the diagnosis.
- Characteristic locations include the superior sagittal sinus at the vertex and torcular Herophili and transverse sinuses at the posterior cranial fossa.
- Commonly associated with thrombosis or compression of the adjacent dural sinus
- Differential Diagnoses:
- Arterial extradural hematoma: Commonly due to injury of the middle meningeal artery; majority are supratentorial, lentiform shaped, sharply demarcated, hyperattenuating, and associated with a skull fracture
- Dural venous sinus compression: Dural venous sinus tapering associated with surrounding extradural hematoma and apparent elevation of dural sinus from the underlying bone
- Dural venous sinus thrombosis: Hyperdensity of the dural sinus on noncontrast imaging and relative enlargement of the sinus with engorged collateral veins; delta sign of intraluminal filling defect on CT venogram
-
Treatment:
- Conservative or surgical management dependent on the location and progression of the injury
- Linear skull fractures parallel to the dural sinus present the highest risk for dural sinus tear with massive bleeding.
Current Issue
Case Collections
