Diagnostic Challenges in Cerebral Venous Thrombosis: Hemorrhagic Presentations and Differential Hypotheses

Abstract Cerebral venous thrombosis (CVT) is a rare, often underdiagnosed condition marked by the formation of thrombi in the cerebral veins and sinuses, which can lead to various clinical symptoms, such as headaches, seizures, and, in some cases, intracranial hemorrhage. This case study presents a 35-year-old hypertensive woman with sudden headache, loss of consciousness, and seizures, who was subsequently diagnosed with CVT complicated by interhemispheric hemorrhage, a rare and challenging presentation. The initial imaging showed frontal interhemispheric hemorrhage and hypodensities, with no arterial abnormalities. Cerebral angiography confirmed CVT due to the absence of opacification in the sagittal sinuses. Treatment involved complete anticoagulation despite hemorrhage, following current guidelines to prevent further thrombotic events. The patient also received anticonvulsants and nimodipine to control seizures and prevent vasospasm, along with close neurological monitoring and blood pressure control. Pneumatic compression was applied to avoid venous thromboembolism due to immobility. This case highlights the diagnostic complexities of CVT, especially when hemorrhage is involved, emphasizing the importance of early, individualized treatment to improve patient outcomes.