Abstract
Cerebral venous sinus thrombosis (CVST) is a rare but potentially treatable cause of stroke, often affecting younger individuals and presenting with non-specific symptoms such as headache, seizures, or altered consciousness. Timely diagnosis is essential but is frequently delayed due to the diagnostic complexity, especially in patients who lack traditional stroke risk factors. This case study highlights a diagnostically challenging presentation of CVST in a middle-aged woman presenting with an atypical headache and no obvious vascular risk factors. Initial non-contrast computed tomography (CT) imaging revealed hemorrhagic infarction, but the diagnosis was only confirmed following CT venography. The case emphasizes the importance of early venous imaging in stroke presentations that exhibit atypical features. We discuss risk factors, the role of direct oral anticoagulants (DOACs), and evolving management strategies, including the screening for underlying prothrombotic conditions. Improved awareness, prompt imaging, and individualized anticoagulation strategies are key to optimizing outcomes in CVST. This case underscores the need for early recognition and multidisciplinary care.