Infectious thrombosis of the superior sagittal sinus with subarachnoid hemorrhage: A case report

Abstract

Rationale: Cerebral venous sinus thrombosis (CVST) represents 0.5% to 1% of all strokes. CVST can cause headaches, epilepsy, and subarachnoid hemorrhage (SAH). CVST is easily misdiagnosed because of the variety and non-specificity of symptoms. Herein, we report a case of infectious thrombosis of the superior sagittal sinus with SAH. Patient concerns: A 34-year-old man presented to our hospital with a 4-hour history of sudden and persistent headache and dizziness with tonic convulsions of the limbs. Computed tomography revealed SAH with edema. Enhanced magnetic resonance imaging showed an irregular filling defect in the superior sagittal sinus. Diagnoses: The final diagnosis was hemorrhagic superior sagittal sinus thrombosis and secondary epilepsy. Interventions: He was treated with antibiotic, antiepileptic, fluids to rehydrate, and intravenous dehydration. Outcomes: After treatment, the seizures did not recur and the symptoms were relieved. One month after the antibiotic treatment, the muscle strength of the patient’s right extremity was restored to level 5, and there was no recurrence of his neurological symptoms. Lessons: We describe a case of infectious thrombosis of the superior sagittal sinus manifested as SAH, which is easily misdiagnosed, especially when patients present with an infection. Clinicians must therefore take care during the diagnosis and selection of the treatment strategy.

Cerebral venous sinus thrombosis presenting as subarachnoid hemorrhage in a neuromyelitis optica spectrum disorder with positive anti-cardiolipin antibodies: a case report

“…Intractable hiccup and nausea (IHN), which can appear early in the course of NMOSD and is often confused with gastrointestinal disease and delayed (1,5) . CVST is a group of cerebrovascular diseases caused by various causes of cerebral venous system circulation disorders, which have a low incidence and mostly present clinically as headache, vomiting, seizures, and focal neurological de cits, but manifest as SAH is only about 1% (6,7) .Unlike aneurysmal SAH, SAH complicated by CVST is limited and small in volume, but the mechanism is not fully understood. It is thought that CVST may be combined with venous infarction followed by hemorrhage rupture and blood in ltration into the subarachnoid space (8) .Stimulation of the convex cortex of the brain by CVST secondary to convex subarachnoid hemorrhage resulting in abnormal cortical ring may be associated with the presence of epileptic seizures in this case (9) .…”