DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.023

Pages: 2216-2222

Cerebral amyloid angiopathy (CAA) is a small-vessel disease characterized by the deposition of β-amyloid in the walls of cortical and leptomeningeal vessels and is an important cause of lobar intracerebral hemorrhage in older adults. Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular disorder for which anticoagulation represents the standard treatment. The coexistence of CAA and CVT is exceptionally rare and creates a major therapeutic dilemma because of the potentially high risk of intracranial hemorrhage. We report the case of an 84-year-old man with a history of two previous episodes of impaired consciousness associated with falls and confusion, requiring intensive care admission in 2021 and 2023, who presented with a two-week history of headache and cognitive impairment. Neurological examination revealed a Glasgow Coma Scale score of 13/15, brisk deep tendon reflexes in all four limbs, and severe cognitive impairment, with a Mini-Mental State Examination score of 11/30 and a Montreal Cognitive Assessment score of 10/30. Brain magnetic resonance imaging showed a right parieto-occipital intraparenchymal hematoma in the liquefaction stage, multiple predominantly lobar cerebral microbleeds, cortical superficial siderosis, a left capsulolenticular lacune, and vascular leukoencephalopathy. Magnetic resonance venography and cerebral angiography demonstrated thrombosis of the left transverse and sigmoid sinuses. The overall hemorrhagic pattern was highly suggestive of probable CAA according to the Boston criteria version 2.0. Given the high hemorrhagic risk associated with the previous lobar hemorrhage, multiple microbleeds, and cortical superficial siderosis, anticoagulation was not initiated. The patient received symptomatic management, including atorvastatin and donepezil, with clinical and radiological monitoring. The coexistence of CAA and CVT represents a rare and challenging clinical situation. Although anticoagulation remains the standard treatment