Persistent intracranial hypertension caused by superior sagittal sinus stenosis following depressed skull fracture

Case report and review of the literature

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✓ Intracranial hypertension caused by a compound depressed skull fracture on the posterior part of the superior sagittal sinus is a rare condition, and nonspecific symptoms and signs can delay appropriate diagnosis and treatment. The authors report on a case of intracranial hypertension that persisted despite conservative treatment, including anticoagulation therapy, which did not improve severe flow disturbance related to the venous sinus compression. Management of this rare condition is discussed and the literature is reviewed.

Abbreviations used in this paper:CT = computerized tomography; MR = magnetic resonance; PIC = α2-plasmin inhibitor–plasmin complex; PT = prothrombin time; PTT = partial thromboplastin time; SSS = superior sagittal sinus; TAT = thrombin–antithrombin III complex.

Article Information

Address reprint requests to: Hiroshi Yokota, M.D., Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan. email: hyokota@nmu-gw.naramed-u.ac.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bone-window (left) and plain (right) CT scans obtained on admission, demonstrating a depressed skull fracture over the posterior portion of the SSS with no parenchymal lesion.

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    Common carotid artery angiogram revealing a severe flow disturbance in the posterior third of the SSS and a nearly smooth tail-like disruption under the depressed skull fracture (arrow), with compensatory drainage provided by the vein of Labbé (arrowhead).

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    Postoperative right common carotid artery angiogram showing good patency of the SSS.

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