A Rare Case of Unprovoked Deep Cerebral Venous Sinus Thrombosis With Associated Petechial Hemorrhage

Abstract

A 73-year-old male with hyperlipidemia and prior squamous cell carcinoma presented with a new-onset generalized tonic-clonic seizure and left-sided weakness. He had a progressively worsening cervical and occipital headache for nine days and was initially evaluated with an unremarkable CT head. The patient arrived at the emergency department with a left gaze deviation, prompting a "Code Neuro." CT angiography (CTA) detected a large dural sinus thrombosis, which was confirmed with a CT venogram and brain MRI. The patient was closely monitored in the intensive care unit and managed with heparin, nicardipine, and hypertonic saline boluses. Neurosurgery opted against surgical intervention. EEG revealed right hemisphere focal dysfunction. Recanalization occurred on hospital day 6. The patient was transitioned to apixaban upon discharge and instructed to follow up with hematology for a hypercoagulable workup. This case highlights the diagnostic complexity of cerebral venous sinus thrombosis (CVST), urging consideration of a differential even in atypical patients. We hope reporting this case will prompt clinicians to consider CVST in patients with non-specific symptoms, leading to timely diagnosis and treatment.