Cerebral venous sinus thrombosis (CVST) is rare and often overlooked, sometimes presenting as an unexplained subdural hematoma (SDH) without trauma. It very rarely accounts for a small proportion of all stroke cases, but carries significant morbidity and mortality if not promptly recognized and treated. We report the case of a middle-aged female who presented with a severe headache, initially diagnosed with SDH, with subsequent imaging revealing extensive dural venous sinus thrombosis. This case underscores the need to consider etiologies beyond conventional causes, including hypertension, trauma, and arterial aneurysm, in patients with intracerebral hemorrhage. Traditional non-contrast neuroimaging often fails to detect these rare thrombotic disorders. In contrast, contrast-enhanced imaging, especially with venography, promptly identifies the pathology. Anticoagulation remains the cornerstone of treatment for dural venous sinus thrombosis, as it prevents thrombus propagation and facilitates recanalization. Improved awareness, a high index of suspicion, and advanced imaging modalities are crucial for accurate diagnosis and, consequently, prompt management.
Hocine et al. (Fri,) studied this question.