The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report|
Goh, Kian Guan & Shanthi, Viswanathan
A 33-year-old lady presented to the emergency department (ED) of Kuala Lumpur Hospital
with subacute onset of headaches, irritability, and vomiting. Neurological examination revealed a
restless agitated patient, poor responses to verbal commands with a Glasgow Coma Scale of 14/15,
photophobia, blurred nasal margins with generalised weakness, hyperreflexia, and downgoing
plantars. Computed tomography (CT) of the brain showed evidence of biparietal infarction with
an empty delta sign. Urgent magnetic resonance imaging and venography (MRI/MRV) of the brain
in the ED showed evidence of thrombosis of the superior sagittal sinus extending to the torcular
herophili, straight sinus, transverse sinuses, sigmoid sinuses, and proximal internal jugular veins.
The precipitating factor for the thrombosis was possibly oral contraceptive pill usage, which she had
been taking for a month. She was treated aggressively with anticoagulation. The patient subsequently
improved symptomatically and achieved full neurological recovery. In this patient, early recognition
of the clinical symptoms and a CT scan with confirmation by MRI/MRV of the brain enabled the
prompt diagnosis and treatment of cerebral venous sinus thrombosis with a good clinical outcome.
cerebral venous thrombosis; computed tomography; magnetic resonance imaging; oral contraceptive; anticoagulation