Pitfalls in the diagnosis and initial management of acute cerebral venous thrombosis

Cerebral venous thrombosis is an important etiology of stroke in young patients. Its clinical manifestations are variable and based on different involved venous or sinus processes. Cerebral venous thrombosis could mimic ischemic infarction and is easy to misdiagnose. Although many patients have favorable outcomes, delayed or incorrect diagnosis due to atypical symptoms may lead to a poor prognosis. Here we present a case of a 33-year-old woman with transient headache and recurrent right extremity weakness whose symptoms progressed and were sustained in the hospital. She was diagnosed with ischemic infarction and recombinant tissue plasminogen activator (rtPA) thrombolysis was performed. However, her symptoms progressed, and intracranial hematoma was found on a computed tomography scan. Ruling out other hemorrhage etiology, we confirmed the presence of cerebral venous thrombosis using magnetic resonance venography. She underwent mechanical thrombectomy and her condition improved thereafter. This case raises the awareness that in young woman patients on oral contraceptives with neurological deficits and headache, cerebral venous thrombosis is a considerable diagnosis. A contrast CT or MRI scan should be ordered in the early course of evaluation, which can help the physician to make the right clinical decision.