Researchers at the Universities of Toronto and Calgary, Canada performed a retrospective case-control study of infants with neonatal cerebral sinovenous thrombosis (CSVT) recruited in the SickKids Children's Stroke Program, Jan 1992-Dec 2006. Blinded neuroimaging review by 2 experts quantified superior sagittal sinus (SSS) compression and head position. Case (n=55) and control (n=90) patients had similar ages and delivery modes. SSS compression occurred in 43% cases and 41% controls (without CSVT and undergoing imaging). SSS compression was significantly associated with CSVT and with greater mean angle toward head flexion (p<0.001). Among CSVT cases, neonates with and without compression had comparable risk factors and outcome. Optimizing head position and/or preventing mechanical SSS compression may improve outcome. 
COMMENT. This study shows an association between superior sagittal sinus (SSS) compression and neonatal CSVT. The authors hypothesize that a lower degree of head flexion in children with CSVT may be explained by greater hypotonia in neurologically impaired neonates leading to a more extended head position. Factors contributing to CSVT include 1) stasis of blood flow, 2) injury to vessel wall, and 3) hypercoagulability (Virschow's triad). SSS compression and restricted head flexion, mechanisms proposed in the above study, differ from most previous investigations of CSVT. Male gender is also associated with CSVT, and a multifactorial process is proposed.
Cerebral venous thrombosis may mimic extraaxial hemorrages on unenhanced head CT, and hemorrhagic venous infarctions may be misinterpreted as parenchymal contusion, leading to an incorrect diagnosis of primary traumatic brain injury in infants.