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Stroke is a common medical emergency resulting from numerous pathophysiological mechanisms and with varied clinical manifestations; as such, the diagnosis of stroke requires diligent clinical assessment. When different stroke syndromes occur in the same patient, it may cause a dilemma in terms of diagnosis and management. This continuing medical education article describes an interesting patient with recurrent neurological events, highlighting the complex pathophysiological processes associated with cerebrovascular syndromes. It offers readers the opportunity to apply their own basic neuroscience knowledge and clinical skills to solve the challenges encountered during the course of diagnosing and treating this patient. Specifically, the article aims to familiarise readers with an approach to diagnosing brainstem strokes and the diverse manifestations of a common stroke syndrome
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Objectives: Cerebral venous thrombosis [CVT] can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman
Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes
Results: A total of 30 patients had CVT. The mean age was 36.8 +/- 11 years and the male-to-female ratio was 2:3. Common manifestations included headache [83%], altered sensorium [50%], seizures [43%] and hemiparesis [33%]. Underlying risk factors were present in 16 patients [53%]. Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts [40%] and major sinus thrombosis [100%]. There were five cases [20%] of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority [77%] had no residual neurological deficits at follow-up
Conclusion: These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes