TRANSVERSE SINUS THROMBOSIS PRESENTING WITH EARLY NEUROCOGNITIVE AND PSYCHIATRIC MANIFESTATIONS: A CASE REPORT

Abstract

Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially life-threatening cerebrovascular disorder with a highly variable clinical presentation. Although headache is the most frequent presenting symptom, neurocognitive and psychiatric manifestations may occur and contribute to diagnostic delay.

We report the case of a 59-year-old woman who presented with severe intermittent headache predominantly in the right occipital region, accompanied by nausea, photophobia, phonophobia gait slowing, and early cognitive disturbances. During hospitalization, intermittent episodes of confusion and visual hallucinations were observed in the absence of focal neurological deficits. Laboratory investigations revealed elevated D-dimer levels. Brain computed tomography demonstrated thrombosis of the right transverse sinus without evidence of parenchymal hemorrhage, mass effect, or midline shift. Electroencephalography and extracranial Doppler ultrasonography were unremarkable. Neuropsychological assessment revealed global cognitive impairment, predominantly affecting attention, memory, visuospatial abilities, and language functions. A short-lasting psychotic episode with preserved insight was confirmed by psychiatric evaluation.

The patient was treated with anticoagulation and supportive therapy, resulting in gradual clinical improvement without the development of new neurological deficits. Follow-up imaging was planned to monitor recanalization.

This case highlights that CVST may present with early neurocognitive and psychiatric symptoms even in the absence of focal neurological signs. Awareness of these atypical manifestations is essential to ensure timely diagnosis and appropriate management.