A case of traumatic superior sagittal sinus injury with spastic paraplegia and magnificent result postoperatively

Skull fracture with superior sagittal sinus injury

Abstract

Trauma-related to head injury in the pediatric age group has various presentations. Among them, depressed skull fractures are more common. Often depressed comminuted skull fractures may penetrate the Dura and even injure underlying brain parenchyma or sinus and lead to massive hemorrhage, thrombosis, ischemia, and even death. Depressed bone fragments over the superior sagittal sinus may injure it causing bleeding from the sinus or compress it obstructing the venous return and leading to venous infarction of brain parenchyma. We report a case of traumatic parietal compound depressed fracture in a 6-year-old boy, who presented with bleeding from the injury site and weakness of bilateral lower limbs. Cranial imaging showed a depressed fragment of the skull compressing the sagittal sinus associated with infarction of the bilateral high parietal region. Surgical intervention for the elevation of the depressed segment of bone and homeostasis was performed. Anticoagulants were not used. Post-operative venogram showed good venous flow at the injured segment of the sinus. Paraplegia improved gradually and the patient was able to walk back home. Immediate intervention to elevate the depressed segment of bone and homeostasis for the depressed bone fragment over the superior sagittal sinus presenting with bleeding from the injury site and paraplegia resulted in a good outcome without prolonged neurological deficit.

Keywords: Paraplegia, Superior Sagittal Sinus Injury, Venography