315 - Right Cerebellar Intraparenchymal Hemorrhage Secondary to Dural Venous Sinus Thrombosis in a Patient With HIV: A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

GA

Glenn Alvarez Arias, BS

medical student
SUNY Downstate Health Sciences University College of Medicine
Brooklyn, New York, United States

Co-Author(s)

AL

Anna Ly, DO

Resident Physician
SUNY Downstate PM&R
Brooklyn, New York, United States
RS

Raheel Shah, DO

Resident Physician
SUNY Downstate
Brooklyn, New York, United States
SA

Sanjeev Agarwal, MD

Attending Physician
SUNY Downstate
Brooklyn, New York, United States

Submitter(s)

GA

Glenn Alvarez Arias, BS

medical student
SUNY Downstate Health Sciences University College of Medicine
Brooklyn, New York, United States

Case Diagnosis: A 64-year-old female with right cerebellar intraparenchymal hemorrhage secondary to dural venous sinus thrombosis in the setting of HIV infection

Case Description: A 64-year-old female with a past medical history of HIV on Biktarvy presented to the emergency room with progressively worsening dizziness and unsteady gait. Non-contrast CT of the brain revealed a right cerebellar intraparenchymal hemorrhage without ventricular extension, hydrocephalus, or uncal herniation. MRV of the brain demonstrated a filling defect in the mid right transverse sinus, likely indicative of dural venous sinus thrombosis. Consequently, the patient was started on Eliquis 5 mg BID. After medical stabilization, she successfully completed her rehabilitation course, achieving measurable functional gains.

Discussions: This case describes a patient with HIV who developed a right cerebellar intraparenchymal hemorrhage secondary to dural venous sinus thrombosis. HIV infection increases the risk of dural venous sinus thrombosis mainly by inducing a hypercoagulable state through chronic inflammation, endothelial dysfunction, immune activation, and deficiencies of natural anticoagulants (protein C and S), with risk heightened in advanced disease. Dural venous sinus thrombosis can rarely cause cerebellar hemorrhage via venous outflow obstruction, leading to hypertension, infarction, and hemorrhagic transformation. MRI and MR venography are most effective for diagnosis. Managing thrombosis with coexisting hemorrhage requires careful anticoagulation. For physiatrists, recognizing that HIV predisposes patients to dural venous sinus thrombosis and cerebellar hemorrhage is essential for rehabilitation planning, prognosis, and multidisciplinary management to optimize recovery while addressing medical complexities.

Conclusions: It is important for physiatrists to recognize that HIV can create a hypercoagulable state leading to neurological complications such as dural venous sinus thrombosis and cerebellar hemorrhage, as this awareness informs prognosis and guides multidisciplinary rehabilitation while managing anticoagulation and HIV-related complexities.