Neuropsychiatric manifestations as an initial presentation of cerebral venous thrombosis: two case reports and literature review

Gerardo Arrieta-Limón, Direction of Education, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Andrea Salgado-Alvear, Direction of Education, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Natalia Dávalos-Cabral, Direction of Education, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Raymundo Solís-Gómez, Direction of Education, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Laura M. Reyes-Martínez, Direction of Education, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Ana V. Herrera-Hernández, Direction of Education, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Fabiola E. Serrano-Arias, Direction of Education; Stroke Clinic. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico

Cerebral venous thrombosis (CVT) is the involvement of the venous sinuses due to the formation of clots that occlude the cerebral veins. It is a rare cause of cerebrovascular disease, accounting for 0.5-1% of cases, with a higher frequency in women under 50 years of age. The most common symptoms are headache, papilledema, seizures, motor and sensory deficits, cranial nerve paresis, and alterations in mental status. Cases with neuropsychiatric manifestations, such as delirium, cognitive impairment, and mutism, have been reported as isolated presentations, although these are limited. Two cases of CVT are presented, both of which exhibited neuropsychiatric manifestations characterized by erratic behavior, aggression, disorientation, depressive, and catatonic symptoms. Treatment for CVT includes addressing the underlying cause, controlling symptoms, and initiating anticoagulation, which has significantly reduced mortality. CVT presenting with mental status alterations without focal neurological deficits is uncommon. In these cases, a temporal association between symptoms and vascular pathology was observed. Although neuropsychiatric manifestations are rare, CVT should be considered in atypical presentations of common diseases.

Keywords: Intracranial thrombosis. Stroke. Cognitive dysfunction. Delirium. Catatonia.