A Rare Case of Cerebral Venous Sinus Thrombosis Presenting as an Acute Focal Neurological Deficit with Autoimmune Hepatitis-related Chronic Liver Disease.

Abstract

Abstract: Cerebral venous sinus thrombosis (CVST) accounts for approximately 0.5%-1% of all strokes. The onset of CVST is usually subacute to chronic, and common clinical presentations are headaches and focal neurological deficits. Patients with chronic liver disease (CLD) are at risk of bleeding as well as venous thromboembolic events. Deep venous thrombosis, thrombosis involving the portal, splanchnic, and hepatic veins, and pulmonary embolism are commonly reported with CLD; however, CVST is not a recognized complication. There are occasional case reports of CVST with hepatitis A or C-related CVST; however, we were unable to find any report of autoimmune hepatitis (AIH)-related CVST in the literature; therefore, we report the case of a 56-year-old female, diagnosed with AIH-related CLD, who presented with sudden-onset confusion and decreased verbal output. She did not have any provoking or underlying hypercoagulable disorder. Her computed tomography (CT) head, followed by magnetic resonance imaging brain, revealed evidence of cerebral venous infarction, and a CT venogram revealed extensive venous sinus thrombosis. Her coagulation profile was deranged, and workup for hypercoagulable state was negative. It was a diagnostic and therapeutic challenge to anticoagulate in the presence of significant derangement of her coagulation profile. The likely etiology for CVST in this scenario was autoimmune liver damage.