Traumatic Cerebral Venous Sinus Thrombosis in Skull Fractures Crossing the Dural Venous Sinuses: Prevalence, Risk Factors, and Timing of Detection

Background: Traumatic cerebral venous sinus thrombosis (CVST) is an underrecognized complication of head trauma, particularly in patients with skull fractures crossing the dural venous sinuses. We investigated the prevalence, risk factors, and timing of CVST detection in this high-risk population.

Methods: This retrospective, single-center cohort study included 357 adults with head trauma and skull fractures crossing the dural venous sinuses. Demographic, clinical, and imaging variables included age, sex, admission Glasgow Coma Scale (GCS) score, fracture location and pattern, malignancy, coagulopathy, and anticoagulation status. CVST and time to radiologic detection were assessed using CT-based imaging. Kaplan-Meier analysis characterized detection over time, while logistic regression evaluated whether scan timing independently predicted CVST detection.

Results: Traumatic CVST was identified in 78/357 patients (21.8%). Lower admission GCS (9.1 vs 12.4, P<.001), complex fracture patterns (P<.001), and fractures involving multiple dural venous sinuses (P=.0007) were significantly associated with CVST. Multiple-sinus fractures had the strongest association, with CVST occurring in 88%. Age, sex, malignancy, and pre-injury anticoagulation therapy were not significantly associated with CVST. Scan timing did not independently predict CVST detection. CVST continued to be detected up to 8.5 days after presentation, beyond 72 hours.

Conclusions: Traumatic CVST was detected in approximately one-fifth of patients with skull fractures crossing the dural venous sinuses, with increased risk associated with lower admission GCS, complex fractures, and involvement of multiple sinuses. Detection beyond 72 hours suggests that fracture anatomy and clinical presentation may help identify patients in whom venous imaging beyond the early post-traumatic period should be considered.