- The document discusses 5 cases of dural venous sinus thrombosis (DVST) following traumatic brain injury in a tropical region of central India. - All 5 patients presented with intracranial bleeding shown on CT scans but had no signs of external head injury. They were found to be dehydrated. - DVST was diagnosed using MRI and MR venography. The patients were treated with low molecular weight heparin and showed improvement without requiring surgery. - The author hypothesizes that dehydration may be an aggravating factor for DVST following traumatic brain injury in hot, dry climates like central India. High clinical suspicion is needed for prompt diagnosis.

1. Dural venous sinus
thrombosis in tropical
region following head
injury
Dr. Shailendra Anjankar

2. Dural venous sinus thrombosis in
tropical region following head injury.
Dr. Shailendra Anjankar
Consultant Neurosurgeon,
SD, SevenStar & Orange City Hospital Nagpur.
Ex –Assistant Professor, JNMC, Sawangi (M),
Wardha
2
TITLE

3. • Dural Venous Sinus Thrombosis (DVST) is rarely
reported as a sequel following traumatic brain
injury (TBI).
• It usually follows hypercoagulable states such as
pregnancy, following skull fracture, and severe
dehydration etc.
INTRODUCTION
Reference: Ciliz D et al. Turkish Neurosurgery. 2008;18:70-7.
Bhatoe HS et al. Neurol India 2015;63:832-3

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• Central India has a tropical semi- arid climate
where the rate of evaporation of water is higher
than the rate of moisture received through
precipitation.
• The temperature of Vidarbha region ranges from
a minimum of 12- 25°C to a maximum of 30-
48°C, with relative humidity varying from 10-15%
to 60-95%
Reference: Tiple AD,et al . Odonatologica. 2013;42:237-45.

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• In emergency room, when CT Brain shows bleed,
it is difficult to differentiate that has the
intracranial bleed caused trauma; or trauma
caused bleed.
Trauma
IC
Bleed

7. • 61-year male, known
case of seizure disorder,
no other co-morbidities,
presented with alleged
H/o RTA.
• He had 1 episode of
seizures and was
brought to hospital in
post ictal state.
• He had no external
injury.
CASE SERIES – CASE 1

8. CASE 2,3,4,5
• All the 5 patients had no
external injury on head and on
CT showed bleed and MRI
Brain with MRV showed
DVST.
• All of them had signs of
dehydration like dry tongue
and decreased skin turgor
with increased blood urea to
creatinine ratio.
• No obvious external head

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• In our small case series of 5 patients, were
treated with Low molecular weight Heparin for 3
to 5 days and on repeat imaging we could not
find any fresh bleed whereas there was
resolution of bleed and cerebral oedema with
symptomatic improvement in headache.
• Fortunately, none of them required surgery, but
strict monitoring of patient’s condition, repeat
imaging plan, and surgery plan was always kept
at stand by.

10. • DVST if diagnosed early and managed promptly
may improve prognosis. Various imaging
modalities can help in early diagnosis if there is
clinical suspicion.
• Treatment includes maintaining good hydration,
anti-edema medications & anticonvulsants.
• Anticoagulation therapy is the first choice in such
cases although it remains controversial in traumatic
brain injury, in view increase risk of bleeding.
DISCUSSION
Reference: Kumar GS, et al. Neurology India. 2004;52:123-4.
Stam J: et al Adv Neurol 92: 233-240, 2003

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• Various hypothesises are given for DVST.
• Carrie and Jaffe stated that abnormalities in the
clotting mechanism, disturbances in blood flow
or damage to the capillary endothelium may
predispose and lead to thrombosis. Pre-existing
coagulopathy may be a factor in predisposing
patients.
• Case series by Delgado Almandoz JE et al
showed strong co-relation between skull
fracture and DVST, whereas in our series we
could not find any.Reference: Carrie AW, Jaffe FA. J Neurosurg 1954;11:173-82.
Delgado Almandoz JE, et al Radiology. 2010;255:570-7.

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• Dehydration is strongly and independently
associated with venous thromboembolism in all
age group and types of patients.
• In this small case series, we found discrepancy in
external injury and internal bleed size in all
patients. DVST needs a high index for suspicion
for prompt diagnosis, and this discrepancy could
be one of the clue for the diagnosis.
Reference: Kelly J, et al. Qjm. 2004;97:293-6.

13. • We included only those patients who had no
external injury,
• Small case series,
• Not investigated for Factor V Leiden, deficiency
of antithrombin, protein C and protein S, elevated
homocysteine.
LIMITATION

14. • In tropical region, where the climate is hot and
dry dehydration may be the aggravating factor for
DVST following TBI.
• DVST needs a high index for suspicion for
prompt diagnosis.
• The discrepancy in external injury and internal
bleed size can serve as one of the clue for
clinical suspicion.
CONCLUSION

15. ACKNOWLEDGEMENT

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