Cerebral venous sinus thrombosis manifesting as chronic spontaneous subdural hematoma: case report and review of the literature

Cerebral venous sinus thrombosis (CVST) is a rare form of stroke that is mainly seen in young women. It is frequently associated with hemorrhagic venous infarction and subarachnoid hemorrhage. There are few reports of CVST associated with chronic non-traumatic subdural hematoma (SDH). The diagnosis of CVST with spontaneous SDH is difficult because of the variability of its clinical features. The management of SDH associated with CVST is controversial and not well-established.

We report a 26-year-old woman with positive COVID-19 serology who presented with superior longitudinal sinus thrombosis associated with chronic spontaneous SDH. She was managed conservatively and treated with anticoagulation and corticosteroids. A follow-up angioscan 1 month after treatment showed regression of the SDH volume with partial repermeabilisation of the thrombosed sinus. Three months later, the follow-up angioscan showed complete resolution of the chronic SDH and superior longitudinal sinus thrombosis with restoration of venous flow.

CVST can also present with spontaneous chronic SDH. The management of SDH concomitant with CVST remains controversial due to the rarity of its presentation and the risks associated with the use of anticoagulation.