Convexity non-aneurysmal subarachnoid hemorrhage caused by cerebral sinus thrombosis: a case report and literature review

Abstract Background: Convexity subarachnoid hemorrhage (cSAH) is an uncommon presentation of subarachnoid bleeding, referring to bleeding more localized to the convexities of the brain. The diagnosis of cerebral venous sinus thrombosis (CVST) can be difficult especially when patients initially present with cSAH. The authors present a case and then discuss the pathophysiology and management. Case presentation: A 56-year-old woman with a previous history of hypertension and ischemic heart disease presented to the emergency department after experiencing it. two seizures following a severe headache. The patient’s history was negative for recent illnesses, head trauma, history of migraines, smoking, alcohol consumption, or intravenous drug use. The patient was diagnosed with CVST based on magnetic resonance venography (MRV). Genetic studies further identified homozygous mutations in the Prothrombin and MTHFR genes. Anticoagulant therapy was initiated with 60 mg of Enoxaparin twice daily and subsequently transitioned to Warfarin after 48 hours continued for 3 months, and then replaced by rivaroxaban. Conclusions: CVST should be considered in the differential diagnosis of patients presenting with cSAH. Considering this point emphasizes the necessity of concurrent diagnosis and management.