An Atypical Stroke Pattern: Cerebral Venous Ischemia Secondary to Left Transverse Sinus Thrombosis

Background: Cerebral venous thrombosis is an uncommon cause of stroke, and venous infarction may mimic arterial ischemia. Recognition of a parenchymal lesion that does not conform to an arterial territory, together with direct signs of venous sinus occlusion, is essential for timely diagnosis.Case presentation: A 39-year-old woman using oral contraceptives presented with sudden-onset headache, repeated vomiting, altered mental status, mild right-sided hemiparesis, and expressive aphasia. Brain magnetic resonance imaging showed focal diffusion-weighted hyperintensity in the left temporoparietal region with a non-arterial distribution, abnormal FLAIR hyperintensity within the left lateral dural venous sinus, and absent post-contrast opacification of the left transverse sinus. The findings supported left transverse sinus thrombosis complicated by venous edema and venous infarction. Low-molecular-weight heparin was initiated promptly. The patient improved progressively and had complete neurological recovery at three months.Conclusion: Cerebral venous thrombosis should be considered in young patients with headache and focal neurological deficits when imaging abnormalities cross arterial boundaries. Careful assessment of venous sinus signal and contrast opacification can expedite anticoagulation and improve outcome.