Abstract
Cerebral Venous Sinus Thrombosis (CVST) is a rare form of venous thrombosis which commonly affects young adults. CVST has variable clinical presentation such as headache, seizure, hemiparesis and even coma, thus mimicking stroke and other neurological disorders. Due to such non-specific wide spectrum of clinical presentations and variable etiology in young adults, CVST can be misdiagnosed easily, especially in initial stages of presentation which consequently affects the outcome and prognosis of the patient. Thus when a previously healthy young adults acutely presented with such variable but primarily neurological clinical presentation, it is vital for medical practitioner to have fine knowledge and skills to suspect CVST as a differential diagnosis. We present two cases: first case is a 21 year old female with puerperal CVST who had caesarean section under spinal anaesthesia three weeks before, who presented with headache and recurrent seizures, followed by hemiparesis; the second case is a 25 year old female with CVST, on oral contraceptives, who presented with right monoparesis, aphasia and facial asymmetry. In both cases though CVST was not the initial diagnosis, it was subsequently diagnosed early and confirmed by MRI brain and MRI angiogram and anticoagulation was commenced effectively, despite associated haemorrhagic infarct in the first case. Both patient made remarkable recovery without any significant residual neurological deficit.
Highlights
Cerebral venous sinus thrombosis (CVST) is characterized by the formation of a clot in the intracranial dural venous sinuses or cortical veins, that drains blood from the brain and is less frequent than the thrombotic and embolic arterial infarctions[1,2].Cerebral Venous Sinus Thrombosis (CVST) is a rare condition affecting commonly young adults and children, primarily neonates[3,4,5]
As in our discussion above, in the first case, the patient presented with fever, generalized tonic-clonic seizures, which progressed to status epilepticus, and left hemiparesis
The first Computer Tomography (CT) brain was normal and basic blood investigations revealed raised WBC, granulocyte count and C-Reactive Protein (CRP), all these mislead the clinician in making the initial diagnosis as being meningoencephalitis associated with seizures and Todd’s paralysis
Summary
Cerebral venous sinus thrombosis (CVST) is characterized by the formation of a clot in the intracranial dural venous sinuses or cortical veins, that drains blood from the brain and is less frequent than the thrombotic and embolic arterial infarctions[1,2]. She has fully recovered with only minimal residual weakness on left arm remaining She had a repeat MRI Angiogram after 3 months, which revealed complete restoration of normal blood flow in the cerebral venous sinuses. A 25 year old female presented to Accident and Emergency Department with complaints of sudden onset of inability to speak, facial asymmetry with loss of muscle power on the right arm and occasional muscle twitching on right arm, which she noticed as she woke up that morning She was previously in good health with only significant past medical history of migraine, which was well controlled with simple analgesics. A control MRI brain with MR Venography was done after 4 months, which revealed complete resolution of superior sagittal sinus thrombosis with restoration of normal flow, as illustrated on figure 13. After 7 months, warfarin stopped by neurologist and changed to aspirin and she is followed-up regularly to this day
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