Central venous sinus thrombosis presenting with generalized tonic-clonic seizures in a patient with no known risk factors

Published:October 10, 2016DOI:
      Central venous sinus thrombosis (CVST) is an uncommon etiology of stroke that predominantly affects women. Nonspecific symptoms include headache, seizure, focal neurologic findings, encephalopathy, and elevated intracranial pressure. We present a case of a previously healthy woman with a new onset seizure, whose only other complaint was weakness despite a normal neurological examination. Her head computed tomography (CT) showed an intraparenchymal hemorrhage of the left frontal lobe and signs of infarction of the right frontal lobe. Magnetic resonance imaging (MRI)/magnetic resonance venography (MRV) revealed a thrombosis in the superior sagittal and right transverse sinus. Further testing revealed a previously undiagnosed malignancy and a previously undiagnosed clotting disorder, both of which contributed to her hypercoagulability. Her case highlights the importance of keeping a high index of suspicion for CVST as examination and CT may be insufficient to make the diagnosis.
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