Isolated Psychiatric Presentation of Cerebral Venous Thrombosis in a Patient Without Risk Factors: A Diagnostic Challenge.
Mahdi Abdulrahman Kanjo, Hanin Abdulbast AboTaleb, Asim Musaad Almalawi et al.
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Case in brief
A 37-year-old healthy woman presented with acute behavioral disturbances, including insomnia and agitation, without prior psychiatric history. Initial investigations, including MRI, were unremarkable, leading to a diagnosis of acute polymorphic psychotic disorder. Six days later, she experienced loss of consciousness and seizures, prompting neuroimaging that revealed cerebral venous thrombosis (CVT) and an intracerebral hemorrhage. Treatment with anticoagulation and antiepileptics resulted in gradual improvement.
What made this case unusual
The case is notable for the isolated psychiatric symptoms as the initial manifestation of CVT in a patient without identifiable risk factors, which is exceptionally rare.
Diagnostic / clinical pearl
Clinicians should consider cerebral venous imaging in patients presenting with atypical acute psychiatric symptoms, as early diagnosis can prevent serious complications.
Why it matters
This case underscores the importance of recognizing that CVT can present with non-specific psychiatric symptoms, potentially leading to misdiagnosis and delayed treatment.