# From Skin to Sinus: A Rare Case of Cerebral Venous Sinus Thrombosis Caused by Occipital Subcutaneous Abscess

## TL;DR

A rare case shows how a scalp abscess led to a dangerous blood clot in the brain's veins, highlighting the need for early detection and treatment.

## Contribution

This is one of the few reported cases of CVST caused by a posterior scalp abscess, expanding clinical understanding of infectious sources.

## Key findings

- A subcutaneous occipital abscess led to thrombosis in multiple cerebral venous sinuses.
- Prompt anticoagulation and antibiotics improved outcomes, with partial recanalization observed after 24 months.
- Neurological symptoms like diplopia resolved over time with close monitoring.

## Abstract

Infectious cerebral venous sinus thrombosis (CVST) typically arises from contiguous infections such as sinusitis or otitis media; however, CVST secondary to a subcutaneous abscess is exceedingly rare.

We report the case of a 68-year-old woman who presented with a fever, headache, and a painful occipital scalp mass. Initial imaging identified a subcutaneous abscess in the occipital region, and subsequent magnetic resonance imaging (MRI) revealed thrombosis involving the superior sagittal, transverse, and sigmoid sinuses. Methicillin-sensitive Staphylococcus aureus (MSSA) was isolated from both blood and abscess cultures. Anticoagulation and intravenous antibiotic therapy were promptly initiated. Diplopia developed on day 10 of illness, was closely monitored through serial neurological examinations, and gradually resolved over the ensuing months, with complete resolution noted at the six-month follow-up. Follow-up imaging at 24 months demonstrated partial recanalization of the affected venous sinuses.

This case underscores a rare but critical progression from a localized scalp infection to CVST. Clinicians should maintain a high index of suspicion in patients presenting with occipital scalp infections accompanied by neurological symptoms. To our knowledge, this is one of the few reported cases of CVST arising from a posterior scalp abscess, expanding the spectrum of infectious sources and guiding management strategies in similar presentations.