Suspected cerebral venous thrombosis in a patient presenting with dizziness and headache

Introduction: Cerebral venous thrombosis (CVT) can present with a variety of clinical findings, such as headache. Imaging of the brain parenchyma and venous structures is important for diagnosis.Case: A fifty-one-year-old woman presented with dizziness that had lasted three years and worsened over the last 3–4 days, together with mild headache extending from the occipital region to the vertex. A language barrier limited the history and examination. Her history included diabetes, hypertension, and hyperlipidemia; her obstetric history included five live births and two miscarriages. No significant lateralizing motor or sensory deficit or ataxia was found. Brain CT showed no acute pathology. Diffusion MRI reported a suspicious hyperintensity in the frontal anterior midline without a clear correlate on the ADC map, and close radiological follow-up was recommended (Figure 1). On MR venography, the left transverse sinus appeared hypoplastic; no thrombus was detected (Figure 2). On verbal review of the images with interventional radiology, however, CVT was considered the leading possibility. The patient was admitted to the neurology ward and enoxaparin was started. Autoimmunity and thrombophilia tests were requested. Venous Doppler ultrasonography of both lower extremities showed no thrombus. There was no clinical progression during hospitalization. She was discharged on enoxaparin and symptomatic treatment. Outpatient review of the pending tests was planned. The case was listed for discussion at the neurovascular council.Discussion/Conclusion: Diagnostic evaluation in suspected CVT requires clinical findings and appropriate venous imaging to be considered together. In this case, there is a discrepancy between the written MR venography report and the verbal consultation opinion. The case is therefore presented not as established CVT but as a patient followed with a preliminary diagnosis of CVT. Re-evaluation of the imaging, completion of the etiological tests, and the council’s opinion are important for clarifying the diagnosis.Keywords: