Abstract
Background:
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. In low- and middle-income countries, delayed diagnosis and limited access to surgical correction can lead to long-term complications. Among these, cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening neurological event, particularly in uncorrected TOF patients.
Case Presentation: We report the case of a 21-year-old female with a known history of uncorrected TOF, diabetes mellitus, and hypertension, who presented with headache, vomiting, new-onset seizures, altered level of consciousness, and right-sided weakness. Imaging studies revealed a left parietal intraparenchymal hemorrhage with features consistent with late subacute CVST. Further evaluation confirmed classical TOF findings on echocardiography. She was managed with intravenous fluids, antiepileptics, antibiotics, and supportive care.
Discussion: CVST in the context of uncorrected TOF remains underrecognized. Chronic hypoxemia, polycythemia, and a hypercoagulable state contribute to the pathogenesis. A review of recent literature reveals a limited number of similar cases, underscoring the rarity of this presentation. This case highlights the need for early neuroimaging and high clinical suspicion when TOF patients present with neurological symptoms.
Conclusion:
This case illustrates a rare but serious neurological complication of uncorrected TOF. Clinicians should consider CVST in the differential diagnosis of cyanotic congenital heart disease patients with acute neurological signs. Early detection and prompt management are essential to improving outcomes in such complex cases