{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:55:22Z","timestamp":1791273322993,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Blast injuries produce complex multi\u2010system trauma through primary barotrauma, secondary penetrating projectiles, tertiary displacement forces, and quaternary mechanisms. Among the most challenging complications is the concurrent presentation of traumatic intracranial hemorrhage and cerebral venous sinus thrombosis (CVST), which creates a profound therapeutic dilemma regarding anticoagulation management. We present a 26\u2010year\u2010old male who sustained injuries from a high\u2010order explosive device that resulted in 19 fatalities. He presented 16\u2009h post\u2010injury with a Glasgow Coma Scale score of 10\/15 and marked quadriparesis with muscle power of 2\/5 in all four limbs. Advanced neuroimaging ruled out cervical spine injury as the etiology of his motor deficits. Non\u2010contrast brain CT revealed a left posterior parietal comminuted and depressed skull fracture with multiple intracerebral bone fragments, associated hemorrhagic contusion, and perilesional edema. CT venography demonstrated extensive thrombosis of the superior sagittal sinus extending to the confluence of sinuses. Chest CT confirmed pulmonary contusions and subcutaneous emphysema. The patient received mannitol for cerebral edema management, phenytoin for seizure prophylaxis, and broad\u2010spectrum antibiotics. Following multidisciplinary consultation, therapeutic anticoagulation was withheld in the acute phase due to substantial risk of hemorrhage expansion from the adjacent contusion and penetrating bone fragments. The patient's neurological status stabilized over five days, though quadriparesis persisted at discharge. He was referred for neurosurgical evaluation and intensive rehabilitation, with anticoagulation initiated one week later. This case underscores that blast\u2010related TBI can produce severe central motor deficits without spinal injury, and that the coexistence of hemorrhagic contusion and CVST often contraindicates early anticoagulation, requiring individualized risk\u2013benefit assessment and multidisciplinary decision\u2010making in severe neurotrauma.<\/jats:p>","DOI":"10.1002\/ccr3.73458","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:15:09Z","timestamp":1788243309000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Anticoagulation Dilemma: Concurrent Traumatic Brain Hemorrhage and Cerebral Venous Thrombosis in a Blast Injury Patient"],"prefix":"10.1002","volume":"14","author":[{"given":"Ayenew","family":"Amare","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine and Critical Care, School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0556-4071","authenticated-orcid":false,"given":"Mikiyas G.","family":"Teferi","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laltu M.","family":"Negasa","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfaye A.","family":"Haile","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care, School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selamawit M.","family":"Bonsu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care, School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalkidan P.","family":"Ageze","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care, School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gedefaw T.","family":"Minwagaw","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care, School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60257-9"},{"issue":"2","key":"e_1_2_15_3_1","first-page":"295","article-title":"Combat Wounds in Operation Iraqi Freedom and Operation Enduring Freedom","volume":"64","author":"Owens B. D.","year":"2008","journal-title":"Journal of Trauma"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2010.1442"},{"issue":"4","key":"e_1_2_15_5_1","first-page":"S104","article-title":"Military Traumatic Brain and Spinal Column Injury: A 5\u2010Year Study of the Impact Blast and Other Military Grade Weaponry on the Central Nervous System","volume":"66","author":"Bell R. S.","year":"2009","journal-title":"Journal of Trauma"},{"issue":"4","key":"e_1_2_15_6_1","first-page":"359","article-title":"Imaging of Traumatic Brain Injury due to Blast Trauma","volume":"39","author":"Bodanapally U. K.","year":"2018","journal-title":"Seminars in Ultrasound, CT, and MR"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e31820a8364"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31828273be"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2007.0484"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-012-0303-6"},{"issue":"4","key":"e_1_2_15_11_1","first-page":"E73","article-title":"Motor Cortex and Spinal Cord Involvement in Blast\u2010Related Traumatic Brain Injury","volume":"70","author":"Kim J. H.","year":"2011","journal-title":"Journal of Trauma"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004728-197807000-00008"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.03799.x"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13381"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.CON.0000446105.67173.a8"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2007.0385"},{"issue":"3","key":"e_1_2_15_17_1","first-page":"S25","article-title":"Surgical Management of Traumatic Parenchymal Lesions","volume":"58","author":"Bullock M. R.","year":"2006","journal-title":"Neurosurgery"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2012.12.027"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2003.50022"},{"issue":"7","key":"e_1_2_15_20_1","first-page":"e663","article-title":"Lung Injury Following Blast Exposure: Current Understanding and Knowledge Gaps","volume":"49","author":"Pannell D.","year":"2021","journal-title":"Critical Care Medicine"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73458","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73458","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:38:27Z","timestamp":1791272307000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/ccr3.73458"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73458","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"assertion":[{"value":"2025-10-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73458"}}