A 42-year-old woman on combined oral contraceptives presents to the emergency department with sudden-onset occipital headache followed by a focal seizure and right-sided hemiparesis. She reports no recent head trauma. Vital signs: BP 148/92 mmHg, HR 102/min, RR 18/min, temperature 37.2°C, SpO2 98% on room air. Neurologic examination confirms right hemiparesis and hyperreflexia. Non-contrast head CT is unremarkable. Subsequent MRI with MRV shows a serpentine hypointense signal on T1-weighted imaging within the left cortical veins with surrounding T2/FLAIR hyperintensity in the adjacent cortex and white matter. No acute arterial territorial infarction is noted. What is the most likely diagnosis?
- A)Acute ischemic stroke secondary to arterial thromboembolism
- B)Reversible cerebral vasoconstriction syndrome (RCVS)
- C)Ruptured arteriovenous malformation with intraparenchymal hemorrhage
- D)Cerebral venous sinus thrombosisGABARITO
- E)Hypertensive intracerebral hemorrhage with secondary vasogenic edema
Explicação
Cerebral venous sinus thrombosis (CVST) is the most likely diagnosis. The clinical presentation—sudden headache, focal seizure, and focal neurologic deficit in a young woman on oral contraceptives—combined with characteristic MRI findings strongly support CVST... Ver explicação completa e trilha adaptativa →