Hemorragia subaracnoidea como forma inusual de presentación de trombosis venosa cerebral. Reporte de caso

Introduction: Cerebral venous thrombosis is defined by the presence of a thrombus in the dural venous sinuses, superficial or deep intracranial veins. It predominantly affects individuals under 55 years of age, with two-thirds of cases occurring in women. Its prognosis is favorable when diagnosed and treated early. Case presentation: A 38-year-old male patient presented with symptoms characterized by generalized tonic-clonic seizures on several occasions, accompanied by altered consciousness, leading to drowsiness with disorientation in time and space. Imaging studies revealed cerebral venous thrombosis with the onset of subarachnoid hemorrhage as an unusual presentation; subsequently, the patient showed signs of intracranial hypertension and uncal herniation, requiring decompressive craniectomy and initiation of anticoagulation, achieving clinical improvement and recovery of functionality. Discussion: Cerebral venous thrombosis is an uncommon cause of cerebrovascular events, with an incidence of 1.3-1.6 per 100,000 inhabitants; up to 30% of patients have no risk factors. Less than 5% is present as subarachnoid hemorrhage associated with cerebral venous thrombosis, and its location in the convexity sulci without involvement of the cisterns at the base points to the affected venous sinus. Conclusions: Cerebral venous thrombosis should be considered in the differential diagnosis of patients with atypical subarachnoid or intracerebral hemorrhage, especially when the cisterns at the base are preserved and located in the convexity sulci, as this may be the initial presentation of venous thrombosis. Early initiation of anticoagulation, even in the presence of hemorrhage, together with decompressive craniectomy, allows the patient to have a favorable outcome with reduced morbidity and mortality.