Cerebral Venous Sinus Thrombosis in the Setting of Hepatic Dysfunction and Viral Hepatitis Seropositivity: A Case Report.

Cerebral venous sinus thrombosis (CVST) is an uncommon yet potentially serious cerebrovascular condition characterized by thrombosis of the intracranial venous sinuses. Its presentation is often nonspecific and clinically variable, which may delay diagnosis. Hepatic dysfunction, including hepatocellular injury in the setting of viral hepatitis seropositivity, may be associated with complex hemostatic changes; however, the relationship between hepatic inflammation and venous thrombosis remains difficult to establish in individual cases. We describe the case of a 35-year-old man who presented with acute left-sided pulsatile headache associated with epigastric pain, vomiting, and mild conjunctival discoloration. Laboratory evaluation revealed elevated hepatic transaminases, mild coagulation abnormality, and positive hepatitis B surface antigen and anti-hepatitis C virus antibody serology, suggestive of hepatocellular injury in the setting of viral hepatitis seropositivity. Neuroimaging demonstrated thrombosis involving the left transverse and sigmoid sinuses with associated hemorrhagic infarction affecting the left temporal lobe and cerebellar hemisphere. The patient was managed conservatively with close neurological and hepatic surveillance and experienced progressive symptomatic improvement. This case highlights the importance of considering CVST in patients with persistent or atypical headache, even when neurological examination is initially nonfocal. Although hepatic inflammation and viral hepatitis seropositivity may represent possible contributing factors, the association remains hypothesis-generating, particularly in the absence of confirmatory viral load testing, cryoglobulin testing, and complete thrombophilia evaluation.