Cerebral venous sinus thrombosis and subdural hematoma in a female patient with systemic lupus erythematosus: a case report and literature review

Cerebral venous sinus thrombosis (CVST) and subdural hematoma (SDH) are extremely rare in patients with systemic lupus erythematosus (SLE), and when conditions are severe, it can endanger the life of the patients. We report a case of a 44-year-old woman who was admitted to our hospital due to multiple paroxysmal headaches, dizziness, and seizures for 20 days. In the past 2 years, she had severe thrombocytopenia. Her brain computed tomography (CT) and magnetic resonance venography (MRV) demonstrated CVST and a SDH near the right parietal occipital lobe and left temporal parietal lobe. After admission, she was eventually diagnosed with SLE based on the seizures, thrombocytopenia, positive antinuclear antibodies, and anti-ds DNA antibodies. After treatment, the patient's headaches and symptoms completely disappeared, and the myodynamia of the left limbs improved to grade 4. Her platelet count rose to 199×109/L. The second brain MRV and MRI demonstrated partial reopening of the right superior sagittal sinus, transverse sinus, and sigmoid sinus, and the improvement of bilaterally SDH, which revealed that the treatment with an anticoagulant, pulse methylprednisolone therapy, and intravenous gamma globulin was effective. We summarized possible mechanisms in this case, which can improve our understanding of CVST and SDH in SLE. And we consider that such patients should be treated as soon as possible, and the outcome can be good.