PMC3806702_01
a, b CT scan following head trauma. c Angiogram shows thrombosis in the TS on the right side (arrow). d Partial recanalisation of the TS (arrow) following 20 mg of tissue plasminogen activator. e CT scan shows progress of a frontal contusion on the left side and new bilateral acute subdural haematomas. f CT scan following bilateral craniectomy.
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F1
A CT scan showed unremarkable findings with only some minimal contusions and otherwise visible sulci on the convexities and open basal cisterns (fig. 1a, b). To exclude venous thrombosis, an angiography was performed 2 days later that showed thrombosis in the right transverse sinus (TS) and contrast stagnation in cortical veins, including the vein of Labbe, as a sign of impaired venous drainage (fig. 1c). Angiographic imaging showed a partial resolution of the thrombus with flow in the TS (fig. 1d), whereas the ICP increased to 70 mm Hg. A CT scan showed newly formed subarachnoid haemorrhage, acute subdural haematomas bilaterally and progress of frontal contusions (fig. 1e). Evacuation of acute subdural haematomas and a bifrontal hemicraniectomy were performed immediately, and the postoperative ICP remained stable at <20 mm Hg (fig. 1f).
PMC3806702_02
a, b CT scan shows cerebellar contusions on the right side and a frontal contusion on the left side. c CT scan with a bone window shows fractures in the posterior fossa engaging the jugular foramen (arrow). d CT venography shows venous thrombosis in the level of the jugular foramen (arrow). e, f CT scan following bilateral craniectomy shows progress of frontal contusions.
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F2
A CT scan showed multiple non-dislocated fractures in the posterior fossa and cerebral contusions in the right cerebellar hemisphere and bifrontally (fig. 2a, b). A new CT scan showed a substantial progress of cerebral oedema and frontal contusions, whereas a CT venography showed a thrombosed sigmoid sinus on the right side, a fractured jugular foramen and a thrombus extending down to the jugular vein (fig. 2c-f).