Cerebral venous sinus thrombosis secondary to acute cytomegalovirus infection

Cerebral venous sinus thrombosis (CVST) is a potentially life-threatening disorder with a number of causes, including viral infections.

A 25-year-old female patient presented with a non-specific febrile illness, headache and hepatitis. She was found to have right transverse sinus and cortical venous thrombosis in addition to acute systemic Cytomegalovirus (CMV) infection. She responded well to anticoagulation with warfarin for 6 months. CMV infection was treated conservatively.

CVST is an increasingly prevalent condition often presenting with headache, focal neurological deficits and seizures. Despite extensive investigations, often no specific cause is found. CMV is a ubiquitous virus that can present with a non-specific febrile illness or a variety of organ dysfunction. CMV has been shown to be associated with predominantly venous thrombosis, most commonly lower limb deep venous thrombosis, pulmonary embolism and splanchnic vein thrombosis. The risk is highest in immunocompromised patients, though most patients are immunocompetent. There have been few reports of CVST related to CMV and all of these with a more tenuous link to acute CMV infection. Clinicians should be aware of this link, particularly in those who have CVST in the context of a febrile illness, or immunocompromised patients.