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Case 9 - Transverse Sinus Injury

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One of the complications of temporal bone

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fractures or occipital bone fractures,

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is injury to the transverse or sigmoid sinus.

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Here we have images from a CT venogram.

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And what you can see is this large collection of blood.

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It's actually not contrast, contrast is much more dense.

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And this is seen in the epidural space associated with

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a comminuted fracture of the occipital bone.

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So here's the comminuted fracture of the occipital bone.

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You have a little bit of air collecting there.

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But what we see on these soft tissue windows is the disruption

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of the transverse sinus with hemorrhage collecting.

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And this hemorrhage, as you can see,

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crosses from the posterior fossa down here with the

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cerebellum and extends into the supratentorial space, across

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the occipital lobe. So if it's going across the tentorium,

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it must be in the epidural space.

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And this can be better demonstrated

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potentially on a sagittal scan,

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where you can see that the collection has

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effectively tracked deep to the torcula,

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which is the confluence of the venous sinuses and goes from

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the posterior fossa into the supratentorial space,

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and displaces the sagittal sinus anteriorly.

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So by virtue of that location, it can't be a subdural location.

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It must be an epidural location.

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When we look at this from the standpoint of the temporal bone,

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we see that on the left side,

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there's a little bit of fluid in the mastoid air cells.

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And as we go further inferiorly,

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we notice that there's some air just adjacent

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to the posterior mastoid air cells here.

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And that likely means that there's a fracture with

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communication into the soft tissue

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at the inferior mastoid tip region.

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And you can see that also in the stylomastoid foramen

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with a small amount of air. On the right side,

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the temporal bone didn't look as bad.

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Just a little bit of fluid communicating

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in the middle ear cavity.

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However, more superiorly,

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we did see a fracture that was involving the superior portion

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of the temporal bone communicating intracranially.

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Remember that communication of these temporal bone fractures

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with the intracranial compartment, renders the patient

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at high risk for CSF leakage and potentially

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intracranial hypotension,

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as well as the complications of meningitis

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and/or a subdural or epidural empyema.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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