• Lingjia Xu and Guoping Fu.
• Department of Neurology, Shaoxing Second Hospital, The Second Affiliated Hospital of Shaoxing University Medical College, Shaoxing, Zhejiang, China.
• Medicine (Baltimore). 2024 Mar 8; 103 (10): e37441e37441.

RationaleCerebral venous thrombosis (CVT) is a relatively uncommon but fatal disease. It can be caused by a variety of hereditary or acquired thrombotic diseases. Initial presentation with intracranial hemorrhage (ICH) in CVT is rare but can further complicate the therapeutic measures and prognosis. Cases of CVT presented with ICH in patients with alcoholic liver disease (ALD) have not been described in the literature, and it might be related with hemostatic abnormalities in ALD patients.Patient ConcernsWe report 2 cases of men admitted to our hospital who were diagnosed with CVT but initially presented with symmetrical crescent-shaped ICH; both of them were ALD patients.DiagnosesCerebral imaging revealed extended CVT in both cases. The first case was a 64-year-old man with ALD deteriorated with unconsciousness and convulsions; computed tomography showed symmetrical crescent-shaped ICH in the right temporal lobe, and magnetic resonance venography revealed CVT. Another 50-year-old man with ALD complained about dizziness and weakness of his right limbs; computed tomography revealed symmetrical crescent-shaped ICH in bilateral parietal and occipital lobes, and magnetic resonance venography revealed CVT.InterventionsThe first patient was referred to the endovascular thrombectomy. Both of them were treated with anticoagulation treatment.OutcomesFavorable outcomes were observed in both patients.LessonsSymmetrical or multiple crescent-shaped ICH requires a high suspicion in the diagnosis of CVT; even with hemorrhage, it is still important to initiate anticoagulation therapy promptly. The crescent-shaped ICH might be a new sign for CVT, and further studies are needed in the underlying mechanisms of ALD and potential thrombophilia.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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