Superior Sagittal Sinus Thrombosis presented as a migraine headache with normal D Dimer.

INTRODUCTION

Superior sagittal sinus thrombosis (SSST) is a rare type of cerebral venous sinus thrombosis (CVST) characterized by blood clot formation in the superior sagittal sinus, leading to increased intracranial pressure. This report highlights a case of SSST presenting atypically as a migraine with normal D-dimer levels, emphasizing the need for thorough evaluation despite normal lab results in at-risk individuals.

PRESENTATION: A 49-year-old female experienced a severe unilateral headache, photophobia, dizziness, and neck tension. She has a history of migraines and hypertension. The patient uses combined oral contraceptives. Examination revealed neck stiffness, and blood pressure of 150/90. CT and D-Dimer were normal. MRV revealed Superior Sagittal Sinus thrombosis and lacunar infarction. Anticoagulation was initiated, leading to good recovery and discharge after 11 days.

DISCUSSION: This case discusses an adult with a history of migraine presenting with a 5-day right-sided throbbing headache, photophobia, dizziness, and neck tension. Despite resembling a migraine exacerbation, red flags indicated a potential secondary cause. Normal D-dimer levels and unremarkable initial CT imaging delayed the diagnosis, but MRV revealed superior sagittal venous thrombosis (SSST) and a Lacunar infarct. Anticoagulation therapy led to significant improvement, and the patient was discharged after 11 days. The case highlights the need for vigilance regarding cerebral venous sinus thrombosis (CVST), in atypical headache presentations.

CONCLUSION

Clinical surveillance is vital for atypical headaches; inconclusive tests may delay diagnosis of superior sagittal sinus thrombosis (SSST). Advanced imaging and early anticoagulation improve outcomes, highlighting the need for high suspicion of cerebral venous sinus thrombosis.