Cerebral Vein Thrombosis an Important Differential Diagnosis of Subarachnoid Hemorrhage (SAH) in Neurology and Neurosurgery

Abstract

Background: Thrombosis of the cerebral veins and sinuses is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects young adult and children. The symptoms and clinical course are highly variable. A teenager who has had recent headaches after starting oral contraception, a woman who has had seizures after delivery in the obstetrical ward, and a comatose man with a dilated pupil in the emergency room all may have sinus thrombosis. A prothrombotic risk factor or a direct cause is identified in about 85 percent of patients with sinus thrombosis. The most frequent but least specific symptom of sinus thrombosis is severe headache, which is present in more than 90 percent of adult patients. It usually increases gradually over a couple of days but can also start in a split second, mimicking a subarachnoid hemorrhage.

Materials and Methods: In this case series study has paid attention to CVT patients who had sudden onset headache and because of their special brain CT scans was misdiagnosed as SAH at first. Its importance is in different management and treatment in these patients (treatment in one kills other patient). In the other hand manifestation of CVT may be as SAH in brain CT scan in witch treatment is completely different from other types of SAH.

Results: Cerebral lesions and neurologic signs develop in half of patients with sinus thrombosis. Characteristic, but rare, is the occurrence of unilateral hemispheric symptoms such as hemiparesis or aphasia, followed within days by symptoms from the other hemisphere; these are caused by the development of cortical lesions on both sides of the superior sagittal sinus.

Conclusion: Anticoagulant therapy and its role in prevention from spreading of clot in the cerebral sinuses and veins is the key of importance in fast diagnosis and treatment and every misdiagnosis may lead to irrecoverable injuries for patients.