A Puzzling Headache : Cerebral Venous Thrombosis
Dr Tan Siang Tai
Emergency and Trauma Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah
Dr Muhamad Faiz Bin Mohd Fauzi, Dr Cheng Hee Song, Dr Fatahul Laham B Mohamed
Cerebral venous thrombosis (CVT) refers to local clot formation and occlusion of intracranial venous structures. CVT is an uncommon form of stroke and usually affects young individual.
We present a case of 24-year-old gentleman who visited to our Emergency Department after developed acute left sided body weakness and numbness with one-month history of chronic right sided pulsating headache. Physical examination revealed a well oriented male in mild distress with normal vital signs. Motor system examination revealed reduced power over left upper and lower limbs. Otherwise, other neurological examination findings were unremarkable. CECT brain was performed immediately and demonstrated increased density over superior sagittal sinus, right transverse sinus and right sigmoid sinus together with filling defects seen within right transverse sinus and right sigmoid sinus suggestive of cerebral venous thrombosis. Subsequent MRV confirmed CT findings and showed new thrombosis of the right transverse sinus, right sigmoid sinus and superior sagittal sinus. Patient was then started on anticoagulant and discharged well from the hospital subsequently.
The diagnosis of CVT is often difficult especially in young male adult and can lead to a delay in treatment. Despite of non-specific and varied symptomatology, headache has been reported as the commonest complaint in young patients. CT brain is the most commonly performed imaging in emergency room. Non-contrast CT findings can be subtle depending on the hyperdensity of the sinus being identified. With contrast administration, computed tomography may show the classic “delta sign”.
This case highlights the importance of keeping CVT in the differential diagnosis when treating a young adult for ongoing headaches. Ability of doctors working in emergency department to detect the aforementioned specific CT brain findings definitely help to shorten the turnaround time for diagnosing CVT in adults in Emergency Department.
Cerebral venous thrombosis, delta sign