| Summary: | Background: Cerebral vein/sinus thrombosis (CVST) is an uncommon cause of stroke. In addition, the varied clinical syndromes present in adults with CVST pose diagnostic challenges. Nonetheless, the rise of CT and MRI as well as the increased awareness of CVST, has improved its recognition. However, CVST presenting on initial imaging as an isolated acute subdural hematoma (SDH) is rare. Further vascular imaging and high clinical suspicion is key to establish the diagnosis. Case description: We present a case of an adult female with Systemic Lupus Erythematous (SLE) who presented to the Emergency Department with several days of worsening headache with no focal neurologic deficit and found to have a spontaneous left tentorial SDH. Given the unusual location for an atraumatic acute SDH further workup with MRI/MRV and digital subtraction angiography (DSA) was performed. Additional tests revealed thrombosis of the left transverse sinus without a concomitant hemorrhagic venous infarct. The patient was started on anticoagulation with dabigatran and was eventually discharged home. The patient was regularly followed up in an out-patient clinic and has remained asymptomatic and at her neurologic baseline. Conclusion: Isolated atraumatic SDH should warrant workup with further vascular imaging on every patient. Investigation should exclude possible underlying arteriovenous shunts, extra axial hemorrhagic lesions, and in this case, the rare possibility of underlying CVST as its cause. If CVST is then found, further workup as to establish its etiology and thus direct the appropriate treatment is warranted.Cerebral vein/sinus thrombosis (CVST) is a very uncommon cause of stroke, accounting for approximately 1% of all strokes. Though the overall incidence of CVST has increased due to advancements in neuroradiology, CVST remains chronically underdiagnosed. The vague radiological presentations and often indeterminant clinical manifestations of CVST pose diagnostic challenges. Atraumatic spontaneous subdural hematoma (SDH) secondary to CVST upon initial imaging is exceedingly rare. High clinical suspicion and radiological acuity is necessary for prompt diagnosis and treatment. We present a case of CVST manifesting a spontaneous left tentorial SDH.
|
|---|