Background: Cerebral venous sinus thrombosis (CVST) is a possible complication of closed head trauma with reported devastating outcomes. Its incidence however is unclear but believed to be frequent in patients with skull base fractures. The natural history of this under-recognized entity is not yet described, but a sensitive screening method is required to definitively address this question. Methods: Case report with literature review. Results: We report the case of a patient that sustained a severe head injury as the pedestrian in a motor vehicle accident. The patient required required a craniectomy to evacuate an acute subdural hematoma. Post-operatively, a CT venogram was performed and showed patent venous sinuses. A few days later, a double order resulted in a CTV being repeated erroneously but revealed the interval development of significant thrombosis of his left transverse sinus extending to his left internal jugular vein. We report on this patient’s outcome and follow-up. Conclusions: Further understanding of sinus thrombosis in the setting of TBI is warranted. The natural history is unclear, and most cases are discovered once symptomatic or after developing complications. Our case shows that current protocols have the potential of missing significant cases and study into the optimal timing of imaging is necessary.