This case report describes concurrent sigmoid sinus thrombosis and bilateral cephalic vein thrombosis following traumatic brain injury and surgical evacuation of an epidural hematoma, successfully treated with subcutaneous enoxaparin.
Key Findings
Background
A 47-year-old male developed concurrent sigmoid sinus thrombosis and bilateral cephalic vein thrombosis following traumatic brain injury and surgical evacuation of an epidural hematoma.
The patient underwent surgical evacuation of an epidural hematoma as the index procedure
Both intracranial venous sinus thrombosis (sigmoid sinus) and peripheral venous thrombosis (bilateral cephalic veins) occurred simultaneously
The co-occurrence of central and peripheral thrombosis indicated a systemic hypercoagulable state
This represents an uncommon presentation, as CVST itself is described as 'an uncommon cause of stroke'
Results
The patient presented with a new headache on postoperative day 5, prompting diagnostic workup.
Symptom onset was on postoperative day 5 following surgical evacuation
The presenting symptom was a new headache
Diagnosis of sigmoid sinus thrombosis was confirmed by CT angiography
Peripheral venous thrombosis of bilateral cephalic veins was confirmed by Doppler ultrasound
Results
Treatment with subcutaneous enoxaparin resulted in symptom resolution and radiologic improvement.
Anticoagulation therapy used was subcutaneous enoxaparin
Treatment was administered in a postoperative setting following recent neurosurgical intervention
Outcomes included both clinical symptom resolution and radiologic improvement on imaging
The case demonstrates that anticoagulation can be safely and effectively used even after recent brain surgery
Discussion
Post-traumatic brain injury and neurosurgery can induce a systemic hypercoagulable state capable of causing both central and peripheral venous thrombosis concurrently.
The concurrent occurrence of sigmoid sinus thrombosis and bilateral cephalic vein thrombosis is attributed to a systemic hypercoagulable state
Both traumatic brain injury and surgical intervention are implicated as contributing factors
The case underscores that CVST 'can co-occur with peripheral thrombosis post-trauma'
The authors emphasize the 'need for vigilance in these complex patients'
Conclusions
Early recognition and anticoagulation are highlighted as crucial management steps for CVST in the postoperative setting.
The authors state that 'early recognition and anticoagulation are crucial for management, even in a postoperative setting'
The case underscores the importance of considering thrombotic complications when new neurological or systemic symptoms arise postoperatively
CT angiography and Doppler ultrasound are identified as the diagnostic modalities used to confirm the diagnosis
Vigilance is specifically recommended in patients with combined traumatic brain injury and surgical history
What This Means
This research describes a case of a 47-year-old man who, after suffering a traumatic brain injury and undergoing surgery to remove a blood clot from his skull (epidural hematoma evacuation), developed dangerous blood clots in two different parts of his body simultaneously. Five days after surgery, he complained of a new headache, which led doctors to discover a clot in one of the major veins draining blood from the brain (sigmoid sinus thrombosis), as well as clots in the veins of both arms (bilateral cephalic vein thrombosis). This was diagnosed using CT angiography for the brain clot and ultrasound for the arm clots.
The patient was treated with a blood thinner called enoxaparin, given as injections under the skin, and his symptoms resolved with improvement visible on follow-up imaging. The simultaneous occurrence of clots in both the brain and the peripheral veins suggests that traumatic brain injury and surgery can push the body into a state where blood clots much more readily than normal — what doctors call a 'hypercoagulable state.'
This research suggests that doctors caring for patients who have had traumatic brain injuries or neurosurgery should remain alert to the possibility of blood clots forming not just in the brain but throughout the body. Even though giving blood thinners after brain surgery carries risks, this case shows it can be done safely and effectively when clots are detected early. The findings highlight the importance of investigating new symptoms like headache in postoperative neurosurgical patients, as they may signal a treatable thrombotic complication.
Li Y, Lin W. (2026). Intracranial Venous Sinus Thrombosis and Peripheral Venous Thrombosis Following Traumatic Brain Injury and Surgery.. The Journal of craniofacial surgery. https://doi.org/10.1097/SCS.0000000000012438