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Introduction: Cerebral venous thrombosis is a rare cause of stroke. It can be presented by various clinical symptoms, depending on the location.

Goal: With help of this unusual case we want to pay attention to a headache as a symptom and the consequences it causes.

Material and methods: We present a 67-year-old female patient who experienced a thunderclap headache in the frontal region. A headache occurred suddenly, after coughing, and was accompanied by vomiting. It lasted for several days and was resistant to analgesic therapy. The patient felt exhausted, with vertigo and was unstable when standing and walking. On admission, the patient complained only of a strong headache, otherwise, her neurological status was normal.

Results: Laboratory blood analysis showed hyperthrombotic state, with increased D-dimers (1520 ng/mL). Other investigations (protein C, S, antiphospholipid antibodies, factor V Leiden, genetic mutations) were normal. Fundus oculi was normal. Urgent CT of the brain revealed bilateral hyperdensity of the transverse sinus, finding suspected for venous thrombosis. MRI of the brain and MR venography could not be performed due to the previous implantation of a filter in vena cava after a car accident. The patient was treated with low-molecular heparin for a period of 2 weeks. Control CT of the brain and  D-dimers were in normal range. The patient was dismissed in a stable condition with recommendation for peroral anticoagulant therapy.

Conclusion: a Headache may be the only clinical manifestation of cerebral venous thrombosis and therefore every a headache ought to be thoroughly investigated and treated.

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Renata Ivanoska | Proud member of MEDGAG | Author

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