We describe a unique case of cerebral venous thrombosis(CVT) in a patient with HIV(Human Immunodeficiency Virus) encephalitis

Although thrombotic events are sometimes seen in HIV patients, venous thrombosis is rare and when present more commonly involves the deep veins. Cerebral venous thrombosis in HIV is a rare occurrence.

We present a 20-year-old young man with HIV/AIDS (Acquired ImmunoDeficiency Syndrome) diagnosed 4 months prior, history of multiple opportunistic infections, HIV cardiomyopathy and HIV encephalitis who developed an acute change in level of consciousness with GCS(Glasgow Coma Scale) dropping from 15 to 5. There was no reported headache, nausea, vomiting or seizures. A CT (Computed Tomography) head showed possible dural sinus thrombosis. A stat CT venogram confirmed a non-occlusive saggital sinus thrombus. MRI(Magnetic resonance Imaging) was negative for venous infarct/hemorrhage or other acute findings. Continuous video electroencephalograph (EEG) monitoring was only indicative of a generalised cerebral dysfunction. Hypercoagulable panel was normal. He was initiated on a heparin drip and GCS improved to 13 within 2 days.

Cerebral venous thrombosis should be included in the differential for patients with HIV/AIDS and HIV encephalitis who develop an acute deterioration of mental status. Typical features like headache, vomiting, seizures need not be present. A high index of suspicion for CVT is crucial to prevent catastrophic outcomes as prompt investigations and initiation of anticoagulation can be life-saving.