Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Sichuan Clinical Research Center for Neurosurgery, Southwest Medical University, Luzhou, China.
Medicine (Baltimore). 2023 Mar 10;102(10):e33218. doi: 10.1097/MD.0000000000033218.
Cerebral venous sinus thrombosis (CVST) represents 0.5% to 1% of all strokes. CVST can cause headaches, epilepsy, and subarachnoid hemorrhage (SAH). CVST is easily misdiagnosed because of the variety and non-specificity of symptoms. Herein, we report a case of infectious thrombosis of the superior sagittal sinus with SAH.
A 34-year-old man presented to our hospital with a 4-hour history of sudden and persistent headache and dizziness with tonic convulsions of the limbs. Computed tomography revealed SAH with edema. Enhanced magnetic resonance imaging showed an irregular filling defect in the superior sagittal sinus.
The final diagnosis was hemorrhagic superior sagittal sinus thrombosis and secondary epilepsy.
He was treated with antibiotic, antiepileptic, fluids to rehydrate, and intravenous dehydration.
After treatment, the seizures did not recur and the symptoms were relieved. One month after the antibiotic treatment, the muscle strength of the patient's right extremity was restored to level 5, and there was no recurrence of his neurological symptoms.
We describe a case of infectious thrombosis of the superior sagittal sinus manifested as SAH, which is easily misdiagnosed, especially when patients present with an infection. Clinicians must therefore take care during the diagnosis and selection of the treatment strategy.
脑静脉窦血栓（CVST）占所有中风的 0.5%至 1%。CVST 可引起头痛、癫痫和蛛网膜下腔出血（SAH）。由于症状的多样性和非特异性，CVST 很容易被误诊。在此，我们报告一例伴有 SAH 的上矢状窦感染性血栓形成。
一名 34 岁男性因四肢强直痉挛性突发持续性头痛和头晕 4 小时就诊于我院。计算机断层扫描显示 SAH 伴水肿。增强磁共振成像显示上矢状窦不规则充盈缺损。
最终诊断为出血性上矢状窦血栓形成和继发性癫痫。
给予抗生素、抗癫痫药物、补液和静脉脱水治疗。
治疗后，未再发生癫痫，症状缓解。抗生素治疗 1 个月后，患者右侧肢体肌力恢复至 5 级，神经症状无复发。
我们描述了一例表现为 SAH 的上矢状窦感染性血栓形成病例，该病易被误诊，尤其是当患者伴有感染时。因此，临床医生在诊断和选择治疗策略时必须谨慎。
