Cerebral venous sinus thrombosis presenting with subarachnoid hemorrhage: a series of 11 cases

Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease with a wide spectrum of clinical manifestations. The aim of this study is to assess the presence of subarachnoid hemorrhage (SAH) in the context of CVST and to present its epidemiological, clinical and radiological/laboratory aspects.

Between October 2012 and October 2019, 43 patients with CVST were reviewed. Eleven (25.58%) cases presented SAH.

A quarter of the patients evaluated with CVST had SAH. There were 9 women (81.82%) and 2 men, with a mean age at presentation of 37.7 years (range 28-49). The most common risk factor was the use of oral contraceptives and the most prevalent symptom was headache. Both sinuses, the superior sagittal sinus and the transverse sinus, were the most affected. There was no isolated involvement of the cortical vein. The SAH was limited to some sulci of cerebral convexity in 8 cases (72.73%). In one case, the location of SAH was in the cerebellum and in two cases in the Sylvian fissure. In two cases, there was an evolution to venous infarction; and in three cases, intraparenchymal hemorrhage was present. Seven patients (63.64%) improved considerably with anticoagulation after 6 months of treatment.

This series found that 25.58% of patients with CVST had SAH. It is the highest incidence described in the literature so far. Findings of SAH located in the cerebral convexities, without affecting the base cisterns, should always lead to the suspicion of CVST.