Aggressive Manifestation of Cerebral Venous Sinus Thrombosis: Rapid Progression from Hemiparesthesia to Spastic Tetraparesis Within 24 Hours in a Young Male – A Case Report

Janaari Pramana Putri Gelgel; Ni Made Yuli Artini; I Putu Dhidhi Pradnya Suryadiarsa

doi:10.35473/jhhs.v8i2.779

Authors

Janaari Pramana Putri Gelgel Bangli Regional Hospital
Ni Made Yuli Artini Bangli Regional Hospital
I Putu Dhidhi Pradnya Suryadiarsa Udayana University

DOI:

https://doi.org/10.35473/jhhs.v8i2.779

Keywords:

cerebral venous thrombosis, cerebral venous sinus thrombosis, venous infarction, tetraparesis, seizure

Abstract

Cerebral venous thrombosis (CVST) is an uncommon cause of stroke, accounting for less than 1% of cerebrovascular events worldwide, and predominantly affects young adults with highly variable and nonspecific neurological manifestations. Delayed recognition may lead to significant neurological deterioration due to venous congestion, cerebral edema, and venous infarction. We report a 33-year-old male who presented with acute right-sided hemiparesthesia upon awakening, preceded by five days of persistent occipital headache. Within hours of admission, he developed right-sided hemiparesis, dysarthria, supranuclear cranial nerve VII and XII palsy, and recurrent generalized seizures. Non-contrast computed tomography revealed a hypodense lesion in the left parietal lobe with hemorrhagic components consistent with venous infarction, along with hyperdensity in the superior sagittal sinus suggestive of cerebral venous sinus thrombosis. The patient was managed with antiepileptic therapy and close supportive care. Within 24 hours, he experienced rapid neurological deterioration progressing to spastic tetraparesis. This case highlights an aggressive clinical course of cerebral venous sinus thrombosis and underscores the importance of early recognition in young patients presenting with acute neurological deficits, particularly when preceded by persistent headache or accompanied by seizures, to prevent delayed diagnosis and severe neurological complications.

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