Diagnostic Challenges of Cerebral Venous Thrombosis Mimicking Brain Tumor: A Case Report

BACKGROUND Cerebral venous thrombosis is a rare but critical stroke subtype that frequently mimics brain tumors on imaging, resulting in diagnostic delays and unnecessary interventions. This case highlights a classic example of cerebral venous thrombosis mimicking a glioma, showing the diagnostic pitfalls and need for heightened clinical suspicion. CASE REPORT A 64-year-old man presented with a 1-month history of recurrent headaches and left lower-limb pain. Initial evaluation revealed markedly elevated D-dimer (7.12 mg/L; normal <0.55) and imaging findings highly suggestive of high-grade glioma: a right frontal heterogeneously enhancing mass with perilesional edema. Notably, contrast-enhanced MRV demonstrated no evidence of venous sinus thrombosis, further supporting the working diagnosis of glioma. Despite thrombotic risk indicators, the patient underwent craniotomy due to progressive neurological symptoms. Histopathology unexpectedly demonstrated thrombotic infarction without tumor cells. Nine months later, recurrent neurological deterioration prompted re-evaluation, with digital subtraction angiography confirming extensive cerebral venous thrombosis involving superior sagittal and transverse sinuses. Therapeutic anticoagulation achieved partial symptom resolution, but residual motor deficits persisted. CONCLUSIONS Cerebral venous thrombosis mimicking brain tumors remains a significant diagnostic challenge. This case emphasizes the importance of integrating clinical, laboratory, and imaging data to avoid misdiagnosis and unnecessary surgery. In patients with atypical imaging features and thrombotic risk factors, preoperative vascular imaging such as digital subtraction angiography or magnetic resonance black-blood thrombus imaging should be strongly considered to avoid misdiagnosis and its potentially devastating consequences.