Beyond aneurysms, subarachnoid hemorrhage unraveling dural venous sinus thrombosis: A rare case report

Background

Dural venous sinus thrombosis (DVST) can be challenging for clinicians, especially when presenting with subarachnoid hemorrhage (SAH)-like symptoms. DVST presents with headache, vision loss, paralysis, and seizures.

Case presentation

We report a case of a 22-year-old male with left-sided weakness, severe headache, and loss of consciousness. Examination revealed left-sided weakness and optic disc blurring. Lumbar puncture showed numerous RBCs. MRI brain with Magnetic Resonance Venography (MRV) revealed “left transverse and sigmoid venous sinus thrombosis and minimal subarachnoid hemorrhage.” A diagnosis of SAH secondary to DVST was made. The patient was treated with Apixaban, resulting in the resolution of DVST and SAH.

Discussion

Dural venous sinus thrombosis (DVST) can pose a diagnostic challenge when it mimics subarachnoid hemorrhage (SAH), presenting with symptoms such as headache, blurred vision, stroke-like features, and seizures. The diagnostic workup includes blood tests, lumbar puncture, and Neuroimaging modalities such as Computed Tomography (CT)/ Computed Tomography Venography (CTV), Magnetic Resonance Imaging (MRI)/ Magnetic Resonance Venography (MRV), Cerebral Angiography, and Digital Subtraction Angiography (DSA). The management strategy for DVST includes supportive management, anticoagulant therapy, and endovascular thrombolysis. The same approach was followed in our case.

Conclusion

This case highlights the need for early recognition of DVST in SAH patients lacking aneurysmal components or basal cistern involvement and its management with anticoagulation if hemodynamically stable.