A case report of cerebral venous sinus thrombosis presenting with rapidly progressive dementia

Abstract

BackgroundCerebral venous sinus thrombosis (CVST) is a rare but serious and treatable cause of neurologic symptoms. Due to the variable clinical presentation, CVST was often misdiagnosed. According to published case reports, common clinical manifestations of CVST include headache, focal neurological deficit, epilepsy, papilledema, etc. It is rare, nevertheless, to mention cases of rapidly progressive dementia (RPD).Case presentationWe reported a case of a 62-year-old retired male accountant, a Han Chinese from eastern China, who initially presented with slow response and memory decline. Until 2 months later, his memory declined and slow response deteriorated significantly, and he could not even complete simple tasks like brushing his teeth, washing his face, washing his feet, and dressing himself, and sometimes developed fecal incontinence. His neuropsychological test demonstrated severe cognitive decline. The cerebrospinal fluid (CSF) studies revealed markedly high opening pressure (260 mm of water), and coagulation tests indicated a mild elevation of D-Dimer of 1.19 mg/L. The magnetic resonance venography (MRV) showed thrombosis of the left transverse sinus, sigmoid sinus, and jugular venous bulb and was diagnosed as CVST. He switched from subcutaneous low molecular weight heparin (LMWH) and transitioned to oral anticoagulants at the time of discharge. The repeated CSF studies revealed normal opening pressure. After 5 days of anticoagulant treatment, his symptoms considerably improved, and a 1-month follow-up revealed that he had fully healed with no signs of recurrence.ConclusionThis case demonstrated the clinical heterogeneity of CVST, which should be taken into account for differential diagnosis of RPD. This case study also offered fresh data for the categorization of the clinical traits and the diagnosis of CVST.

The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia

“…9 Subacute or chronic cases of severe cognitive dysfunction have also been observed in cerebral venous thrombosis and classified under the category of rapidly progressive dementia. 37 Perhaps the most atypical psychopathological feature of our case is the catatonic syndrome, which has only been reported a few times. Gangadhar et al 6 described the case of an 18-year-old woman who presented with catatonia and had a lethal outcome, and the autopsy diagnosis was cerebral venous thrombosis.…”

“…Delirium, which is also known as acute confusional state, has been reported in cerebral venous thrombosis since the publication of a classical series of 38 cases in 1985 9 . Subacute or chronic cases of severe cognitive dysfunction have also been observed in cerebral venous thrombosis and classified under the category of rapidly progressive dementia 37 …”

Arterial Spin Labelling Magnetic Resonance Perfusion Imaging for the Diagnosis of Acute Cerebral Venous Thrombosis

“…When conventional cranial MRI and head CT yield inconclusive results, the possibility of CVT cannot be definitively ruled out, necessitating further assessment through MRV. [6,17] In cases where contrast agents cannot be administered, MRV's sensitivity and specificity diminish, potentially leading to false-negative or false-positive outcomes. [10] In our study aimed at evaluating the impact of the ASL-MRP technique on CVT diagnosis, we observed an increase in CBF in five out of six patients with acute CVT.…”

“…[5] However, the identification of CVT can sometimes face delays or challenges due to atypical clinical manifestations. [6] Although computed tomography (CT) and magnetic resonance (MR) angiography are recommended diagnostic tools for detecting CVT, these methods have limitations. [7,8] They include issues such as false negatives/positives, susceptibility to motion artefacts, extended examination times and reduced sensitivity in cases where contrast agents cannot be used, particularly in non-contrast-enhanced time-of-flight (TOF) MR venography (MRV).…”