Cerebral venous sinus thrombosis presenting as subarachnoid haemorrhage

Excerpt

A 38-year-old male presented with sudden onset of severe holocranial headache which was the worst headache of his life. It was also associated with two to three episodes of vomiting. After a period of 6 h, he also developed some weakness in his right arm. There was no history of fever, diplopia, seizures and loss of consciousness or preceding trauma. The patient was not a known case of hypertension or diabetes mellitus. On examination, his BP was 140/80 and pulse rate 70/min. His neurological examination revealed weakness in the right arm (power 4/5, MRC grade) with brisk reflexes. Neck rigidity and Kernig’s sign were absent. There was no anisocoria or papilledema. Bilateral cranial nerves were normal. His non-contrast CT head showed hyperdensity in the left central sulcus suggestive of subarachnoid haemorrhage. T2 FLAIR images showed hyperintensity in the left central sulcus. GRE images showed blooming at the same site. There was no sign of cortical vein thrombosis on MRI. His MR angiogram did not reveal any aneurysm. The MR venogram revealed filling defect in the superior sagittal sinus (Fig. 1). His routine haematological examination including haemoglobin, total leukocyte count, differential leukocyte count, and platelet count were normal. Serum biochemistry including sugar, liver function tests, urea, creatinine, sodium, and potassium was also normal. Coagulation profile including prothrombin time, international normalized ratio (INR), and activated partial thromboplastin time (aPTT) was also normal. The levels of protein C, protein S, and anti-thrombin III were normal. The test for antiphospholipid antibody was also negative. In our investigations, no risk factor or aetiological factor was found. He was treated with low molecular weight heparin followed by oral anticoagulation. He recovered completely within 7–10 days.

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