Cerebral Venous Sinus Thrombosis Mimicking Tumor Hemorrhage: Successful Anticoagulation in a Resource-Limited Setting.

Cerebral venous sinus thrombosis (CVST) is a rare yet potentially reversible etiology of stroke that frequently presents with nonspecific symptoms, contributing to delayed diagnosis. Aphasia, commonly associated with arterial infarcts, may also occur in CVST when thrombosis involves cortical veins responsible for language function. We report a case of a middle-aged female who presented with expressive aphasia and headache. Initial non-contrast computed tomography (CT) revealed hemorrhagic changes suggestive of tumor-related bleed. However, subsequent magnetic resonance venography (MRV) confirmed CVST involving the left transverse sinus. Anticoagulation with low molecular weight heparin (LMWH) was initiated despite the presence of hemorrhagic venous infarction and was well tolerated, leading to progressive clinical improvement. This case underscores the diagnostic challenges posed by CVST when imaging mimics neoplastic hemorrhage and highlights the importance of early venographic imaging. Timely recognition and initiation of anticoagulation, even in the presence of hemorrhage, remain critical to achieving favorable outcomes.