Infectious thrombosis of the superior sagittal sinus with subarachnoid hemorrhage: A case report

• Published in: Medicine (Baltimore) Vol. 102; no. 10; p. e33218
• Main Authors: Li, Junxi, Li, Shenjie, Zhang, Junrong, Wen, Yuqi, Wang, Ke, Luan, Xingzhao, Xiang, Wei, Chen, Ligang, Zhou, Jie
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 10.03.2023
• Subjects: Adult; Clinical Case Report; Headache - diagnosis; Humans; Magnetic Resonance Imaging - adverse effects; Male; Sagittal Sinus Thrombosis; Seizures - complications; Sinus Thrombosis, Intracranial - complications; Subarachnoid Hemorrhage - etiology; Superior Sagittal Sinus; Thrombosis - complications
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000033218

Cerebral venous sinus thrombosis (CVST) represents 0.5% to 1% of all strokes. CVST can cause headaches, epilepsy, and subarachnoid hemorrhage (SAH). CVST is easily misdiagnosed because of the variety and non-specificity of symptoms. Herein, we report a case of infectious thrombosis of the superior sagittal sinus with SAH. A 34-year-old man presented to our hospital with a 4-hour history of sudden and persistent headache and dizziness with tonic convulsions of the limbs. Computed tomography revealed SAH with edema. Enhanced magnetic resonance imaging showed an irregular filling defect in the superior sagittal sinus. The final diagnosis was hemorrhagic superior sagittal sinus thrombosis and secondary epilepsy. He was treated with antibiotic, antiepileptic, fluids to rehydrate, and intravenous dehydration. After treatment, the seizures did not recur and the symptoms were relieved. One month after the antibiotic treatment, the muscle strength of the patient's right extremity was restored to level 5, and there was no recurrence of his neurological symptoms. We describe a case of infectious thrombosis of the superior sagittal sinus manifested as SAH, which is easily misdiagnosed, especially when patients present with an infection. Clinicians must therefore take care during the diagnosis and selection of the treatment strategy.