Abstract Text

Background: 

Non-aneurysmal non-traumatic subarachnoid hemorrhage [SAH] are rare. We present a rare case of cerebral venous sinus thrombosis [CVT] presenting as SAH.

Case Report: 

A 68 year male with hypertension and diabetes, presented with acute headache, vomiting, imbalance, confusion and gait ataxia for 3 days. NCCT head revealed linear hyperdensities in bilateral fronto parietal region and quadrigeminal cistern suggesting diffuse SAH. Contrast CT head and Neck angiography [CTA] ruled out aneurysm and so he was managed conservatively under neurosurgery team. A review of CTA suggested reduced contrast intake on right transverse sinus during venous phase. MRI venogram depicted thrombosis involving right sigmoid and transverse sinus and internal jugular vein. His risk factors were male, hypertension and diabetes mellitus, anemia and dehydration. Workup for hypercoagulable state and screening for occult malignancy was negative. In view of massive SAH associated with the fact that he came from a remote village where Prothrombin Time [PT] and International Normalized Ratio [INR] monitoring would be difficult, aspirin was used along with anti-hypertensives and anti-epileptics. CVT generally presents with venous infarcts with haemorrhage.  There are only nearly 70 cases published describing CVT presenting as SAH with the postulated mechanism being leak of small vessels due to increased venous pressure and oedema. 

Conclusion:
 We report a diffuse SAH involving convexities as well perimesencephalic region as a presentation of CVT which is very rare. A detailed review of the venous phase of CT angiogram is important in all cases of non traumatic non-aneurysmal SAH. 

Key words: cerebral venous thrombosis, subarachnoid hemorrhage, stroke

Non traumatic, non aneurysmal subarachnoid hemorrhage as an unusual presentation of cerebral venous sinus thrombosis.