Overcoming Diagnostic and Management Hurdles: A Case Report on Superior Sagittal Sinus Thrombosis with Subarachnoid Hemorrhage

Abstract

Cerebral venous thrombosis (CVT) is a rare but critical condition, presenting significant diagnostic challenges due to its varied clinical manifestations. This report underscores the complexity of the superior sagittal sinus thrombosis diagnosis and management, highlighting the need for heightened clinical awareness and prompt intervention. We present a case of a 47-year-old male with a history of cerebral aneurysm, who arrived at the emergency department exhibiting acute neurological symptoms, including loss of consciousness, seizures, and muscular contractions, without any recent history of trauma or medication use. Neurological examination showed a Glasgow Coma Scale (GCS) of 15, with specific findings suggesting a significant neurological impact. Neuroimaging revealed subarachnoid hemorrhage in the left interhemispheric fissure and thrombosis of the superior sagittal sinus. Despite the complex presentation and rapid progression of symptoms, a multidisciplinary approach involving continuous monitoring, decompressive craniectomy, and subsequent rehabilitative measures led to a significant improvement in the patient's condition. This case illustrates the critical nature of superior sagittal sinus thrombosis, and the challenges associated with its diagnosis and management. It emphasizes the importance of considering CVT in the differential diagnosis of acute neurological events and the effectiveness of a comprehensive, multidisciplinary approach in managing such complex cases. The positive outcome in this case contributes to the growing body of evidence supporting aggressive intervention strategies in managing CVT.