Extensive cerebral venous sinus thrombosis with hemorrhagic venous infarction as the initial presentation of acute myeloid leukemia: A case report

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke in young adults and may present with nonspecific symptoms, leading to delayed recognition. Although CVT is associated with multiple acquired and inherited prothrombotic states, presentation as the first manifestation of acute myeloid leukemia (AML) is distinctly uncommon and poses diagnostic and therapeutic challenges, particularly when intracranial hemorrhage is present. We report the case of a 34-year-old woman with no significant past medical history who presented with sudden severe headache, vomiting, photophobia, and right-sided blurry vision. Initial noncontrast computed tomography (CT) of the brain demonstrated a right lateral occipitotemporal intraparenchymal hemorrhage with surrounding edema and hyperdense dural venous sinuses suspicious for venous thrombosis. CT venography confirmed extensive dural venous sinus thrombosis involving the straight sinus, right transverse and sigmoid sinuses, posterior superior sagittal sinus, with extension to the right internal jugular vein and involvement of the vein of Galen. Laboratory evaluation revealed leukopenia with severe neutropenia, macrocytic anemia, and borderline thrombocytopenia; peripheral smear showed circulating blasts, prompting hematologic workup. Bone marrow examination demonstrated marked blast infiltration with immunophenotypic features consistent with AML without maturation. This case underscores the importance of evaluating for underlying hematologic malignancy in patients presenting with extensive or unprovoked CVT, especially when cytopenias or abnormal peripheral blood findings are present, and highlights the need for early multidisciplinary management when thrombosis coexists with intracranial hemorrhage.