Ulus Travma Acil Cerrahi Derg. 2010; 16(1): 98-102

Venous sinus thrombosis after closed head injury: case report

Bülent Bakar, Ýsmail Hakký Tekkök
Mesa Hospital

Dural sinus thrombosis after closed head injury is seen very rarely and its pathophysiological mechanisms are not yet understood. An 18-year-old man who had been crushed in an automobile had closed head injury with Glasgow Coma Score 4. Computerized tomography showed diffuse cerebral edema and right occipital linear fracture extending to the internal jugular foramen. Because of high- level intracranial pressure, he underwent bilateral frontotemporoparietal craniectomy. After surgery, magnetic resonance scan with venography showed that the right internal jugular vein was obliterated from the torcular Herophili and the left internal jugular vein was very thin in calibration. He was discharged home with Karnofsky performance score of 30/90. Dural sinus thrombosis with dominant side can carry high morbidity and mortality if not treated immediately.

Keywords: Dural sinus thrombosis, closed head injury; internal jugular vein; sagittal sinus.

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Kapalý kafa travmasý sonrasý venöz sinüs trombozu: Olgu sunumu

Bülent Bakar, Ýsmail Hakký Tekkök
Özel Mesa Hastanesi, Nöroþirürji Servisi, Ankara

Kapalý kafa travmasý sonrasý oluþan dural sinüs trombozlarý nadir görülür, patofizyoloji mekanizmalarý henüz tam olarak bilinmemektedir. On sekiz yaþýnda erkek hasta, araç dýþýna fýrladýðý yüksek enerjili trafik kazasý sonrasý Glasgow Koma Skalasý skoru 4 (Tüp ile)/ 15 saptandý. Bilgisayarlý tomografide diffüz serebral ödemle beraber sað juguler foramene uzanan oksipital lineer kýrýk saptandý. Tedaviye raðmen ÝKB deðerlerinin yüksek seyretmesi üzerine ameliyata alýnarak bilateral fronto-temporo-parietal kraniyektomi yapýldý. Beyin manyetik rezonans venografide sað juguler venin torkula düzeyinden itibaren oblitere olduðu ve sol juguler ven kalibrasyonunun ince olduðu görüldü. Bir dizi tedavi sonrasý hasta Karnofsky performans skalasý 30/90 olarak evine taburcu edildi. Erken dönemde tedavi edilmeyen özellikle dominant dural sinüs trombozlarý, ciddi düzeyde morbid ya da ölümcül seyretmekte ve erken teþhis ve tedaviyi zorunlu kýlmaktadýr.

Anahtar Kelimeler: Dural sinüs trombozu, internal juguler ven; kapalý kafa travmasý; sajital sinüs.

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