Acute Subdural Hematoma: A Rare Manifestation of Cerebral Venous Sinus Thrombosis

Abstract

Cerebral venous sinus thrombosis (CVST) usually presents with headaches, seizures, and signs and symptoms of raised intracranial pressure (ICP). Risk factors for CVST commonly include hypercoagulable states such as pregnancy and the peripartum period, dehydration, vitamin B12 deficiency, hyper-homocysteinemia, coagulation factor deficiency, antiphospholipid antibody disease, oral contraceptive pill intake, etc. CVST with venous hemorrhagic infarction is commonly reported, but only a few cases have been reported in the literature of CVST presenting as SDH. Here, we present a case of a 28-year-old female who presented with an acute onset of severe headache, vomiting, and bilateral papilledema on fundus examination. She had a prior history of oral contraceptive pill intake. An MRI brain venogram suggested CVST involving the superior sagittal sinus, right transverse, and a few cortical vein thromboses with subdural hematoma (SDH) in the frontal-parieto-temporo-occipital region on the right side. The patient was treated with anticoagulants and antiepileptics and had significant improvement in symptoms with the resolving SDH on subsequent scans.

Keywords: acute subdural hematoma; acute subdural hematoma with cvst; cerebral venous sinus thrombosis (cvst); sdh with cvst; subdural hematoma (sdh).

Figure 1. Magnetic resonance imaging of the brain (T2/FL) Air sequence showing crescent-shaped extra-axial hyperintensity and loss of flow void in superior sagittal sinus and few cortical vein thrombosis. Magnetic resonance imaging of the brain venogram suggests superior sagittal sinus, right transverse, and few cortical vein thrombosis.

DWI: Diffusion-weighted imaging, ADC: Apparent diffusion coefficient, FLAIR: Fluid-attenuated inversion recovery, GRE: Gradient recalled echo, MRV: Magnetic resonance venogram.

Figure 2. Computed tomography (CT) brain plains: on days three and eight of treatment.