OBJECTIVE AND IMPORTANCE: Thrombosis of the internal jugular vein (IJV) with associated elevated intracranial pressure (ICP) is a rare complication of central venous catheterization but has not been reported as a result of blunt trauma.
CLINICAL PRESENTATION: An 18-year-old male patient was observed to be obtunded after an assault. The initial examination was remarkable for somnolence, bruising of the anterior neck, and diffuse, edematous swelling of the face and scalp. The results of computed tomography of the brain were normal. An angiogram obtained on the 2nd hospital day to rule out carotid injury revealed bilateral IJV thromboses to the cranial base. An ICP monitor was placed with an opening pressure of 33 mm Hg. The central venous pressure was measured to be 9 mm Hg. A catheter was passed through the left IJV thrombus and into the sigmoid sinus, where the pressure was 17 mm Hg.
INTERVENTION: An intravascular stent was deployed in the left IJV. ICP rapidly normalized. A regimen of coumadin was administered to the patient for 6 weeks, at which time the stent remained patent.
CONCLUSION: We conclude that traumatic jugular vein thrombosis can be associated with significant elevation in ICP and that treatment with an endovascular stent can affect the rapid correction of intracranial hypertension in patients who are candidates for anticoagulation.
Some thoughts: somnolence as a symptom of thrombotic outflow obstruction of the jugulars is similar to fatigue in ccsvi outflow obstruction of the jugulars.
Traumatic assault can damage jugulars. Had only one been damaged, it might have gone undiagnosed.
Clotting extended the length of the jugular to the cranial base. Only one jugular was cleared. It is not said if the other one was unable to be cleared or if this was a choice to clear only one. The jugular was stented. The patient, with one occluded jugular and one stented jugular, is at risk for intimal hyperplasia or clotting in the stent. With the youthful age of the patient, I wonder if he is at risk for MS too.