Cerebral venous
sinus thrombosis after mild
head trauma without
skull fracture or intracranial
hematoma is exceptionally rare. We describe an unusual case of progressive
intracranial hypertension due to superior sagittal sinus
thrombosis following mild
head trauma. A 17-year-old boy presented with nape
pain a day after a head blow during a gymnastics competition (backward double somersault). On admission, he showed no neurological deficit. CT scans revealed no
skull fractures, and there were no abnormalities in the brain parenchyma. However, his
headache worsened day-by-day and he had begun to vomit. Lumbar puncture was performed on Day 6, and the opening pressure was 40 cm of water. After tapping 20 mL, he felt better and the
headache diminished for a few hours. MR venography performed on Day 8 revealed severe flow disturbance in the posterior third of the superior sagittal sinus with multiple venous collaterals. Because of the beneficial effects of lumbar puncture, we decided to manage his symptoms of
intracranial hypertension conservatively with repeated lumbar puncture and administration of
glycerol. After 7 days of
conservative treatment, his symptoms resolved completely, and he was discharged from the hospital. Follow-up MR venography performed on Day 55 showed complete recanalization of the superior sagittal sinus. The exact mechanism of
sinus thrombosis in this case is not clear, but we speculate that endothelial damage caused by shearing stress because of strong rotational acceleration or direct impact to the superior sagittal sinus wall may have initiated
thrombus formation.