Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: a Case Report

Abstract

Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present the case of a man with CVT of the right transverse sinus who presented with a SAH in the right parietal sinus. In this case, we describe a hyper-homocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance of identifying possible causes that could be reversed with an appropriate treatment, and the controversy about the timing for starting anticoagulation therapy in such cases.

Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis

“…Since intracranial venous hypertension is a characteristic clinical feature of cerebral venous and sinus thrombosis, reports of associated venous rupture such as PNSAH and convexal SAH should not be surprising. [ 17 , 31 – 34 ] In our case, the occurrence of PNSAH was associated with transverse sinus thrombosis, an occurrence not yet previously reported. In our case, the venous phase of DSA demonstrated an absence of normal venous outflow of the right transverse sinus and prominent cerebral veins as extensive collateralizations.…”

Cerebral Venous Thrombosis Associated with Intracranial Hemorrhage and Timing of Anticoagulation after Hemicraniectomy

“…Of the case reports involving CVT patients presenting with ICH, the range of time initiating anticoagulation ranged from immediately upon diagnosis of CVT and ICH, [15][16][17] to the second day of admission, 18 and up to 1 month after diagnosis. 18 One case report stated that anticoagulation with low-molecular-weight heparin was maintained for 2 weeks before starting dabigatran, but there was no statement on when low-molecular-weight heparin was initially started.…”

Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage

“…: cerebral venous thrombosis (CVT),1) reversible cerebral vasoconstriction syndrome (RCVS),4) vascular malformations, vasculitides,12) infectious aneurysms,10) Moyamoya disease or syndrome,22) severe carotid atherosclerosis,6) posterior reversible encephalopathy syndrome (PRES),24) cerebral amyloid angiopathy (CAA),5) and nonvascular disorders, such as primary and secondary brain neoplasms7) or abscess 18)…”