Background: Cerebral Venous Thrombosis is an underdiagnosed form of stroke. Its presentation as association of headache with visual symptoms is unusual in literature, particularly in patients without predisposing factors; so, the diagnosis is often delayed, especially by the non-neurologists. The case is discussed in the light of diagnostic challenge and how an understanding of the basic sciences can explain its clinical presentation.

Design/results: We present a case of a 59-year-old man admitted with severe headache and visual blurring, whose complementary exams confirmed the presence of cerebral venous thrombosis in the cavernous sinuses. For his diagnose, numerous
laboratorial and images exams, including contrast-enhanced MRI of the brain were performed. He was handled with dexamethasone and heparin. Later, on further investigation for thrombophilia, it was found a mutation in the prothrombin gene.

Conclusions: Less-common diagnoses can be easily missed or delayed if a reasonable suspicion does not exist when considering possible causes. Cerebral venous thrombosis (CVT) is one such uncommon, seldom-considered disease that carries a significant morbidity and mortality. Due to its diversity of signs and symptoms, cerebral venous thrombosis may mimic other diseases. High index of suspicion is very important for a better outcome.

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