Headache and seizures

A 57-year-old man was admitted to the emergency department of our hospital. Two days before admission, he had a headache, followed by left hemiplegia. On the next day, he experienced two episodes of seizure (generalized tonic-clonic) and each one continued for five minutes and he was not conscious between the two episodes. After the seizures, the patient's consciousness remained low. On admission, the patient was unconscious and agitated. His past medical history was unremarkable for any chronic diseases including diabetes mellitus, hypertension, and ischemic heart disease. The only considerable point was the SARS-CoV-2 infection three weeks ago and his symptoms were completely recovered. He did not have a history of head trauma. He did not smoke and did not use any kind of drugs before admission. On the first visit, the Glasgow Coma Scale (GCS) was two, vital signs including blood pressure, respiratory rate, heart rate, and temperature were within normal ranges, and O2 saturation was 87.5%. The pupils were mid-dilated and were not responsive to light. The doll's eye reflex was positive. Respiratory, abdominal, heart, and other physical examinations were unremarkable. The patient was admitted to the intensive care unit (ICU) and was intubated due to unconsciousness and agitation. Also, the first dosage of diazepam and sodium valproate was administered. Initial laboratory evaluations were performed, and Midazolam, dexamethasone, phenytoin, sodium valproate, vancomycin, and meropenem were administered. On the second day of admission, the patient was auto-extubated due to agitation. O2 saturation was 96%, so after extubation, the patient was only supported by an O2 face mask. A brain CT scan was requested, and it revealed thrombosis in cortical veins and right transverse sinus in addition to subarachnoid hemorrhage (SAH). D-Dimer test was done, and the result was 4654 ng/ml.