A CASE OF CEREBRAL VENOUS SINUS THROMBOSIS SIGNALED BY BILATERAL OPTIC DISC EDEMA AND UNILATERAL VITREOUS HEMORRHAGE

Title A CASE OF CEREBRAL VENOUS SINUS THROMBOSIS SIGNALED BY BILATERAL OPTIC DISC EDEMA AND UNILATERAL VITREOUS HEMORRHAGE
Author, Co-Author Mayra Rullan, Rolando Ortiz
Topic
Year
2007
Day
Wednesday
Program Number
075109
Room
Affiliation
Inter American University of Puerto Rico, School of Optometry
Abstract BACKGROUND: Cerebral venous sinus thrombosis is a rare condition.It can present acutely, subacutely or chronically and can occur at all ages.The condition can present itself with a variety of clinical signs and symptoms. Among the clinical manifestations, headaches, disc edema or papilledema, dizziness and focal neurological deficits are the most common. With such a variation in the clinical picture, neroimaging specifically a magnetic resonance venography (MRV)becomes the key to correct diagnosis.




CASE REPORT(S): A 22 y/o male comes as an emergency with the complaint of 1 week onset of pain OD associated with vision of a shadow out of his right eye. He went to an ophthalmologist who diagnosed sinusitis and prescribed oral antibiotics. His best corrected visual acuities are 20/70 OD and 20/25 OS. Pupils, color vision and EOM's are normal OD and OS. Dilated fundus exam shows bilateral disc edema more in the right eye and a boat shaped pre-retinal hemorrhage in the right eye. A CT scan and lumbar puncture are normal. An MRI with gadolinium and MRV reveals a left transverse sinus and sigmoid sinus thrombosis of acute type. Medical evaluation finds no etiololy for the venous thrombosis.The patient is hospitalized and treated with Diamox 250mg IV q6h and coumadin 5 mg PO daily. A week later he is discharged with a prescription for Diamox 250 mg PO q6h and Coumadin 5mg PO QD.

CONCLUSIONS: At a six month follow-up the patient is tapered down to Diamox 250 mg PO and continues Coumadin 5 mg PO. His best corrected visual acuities are 20/20 OD and OS and the ONH edema has improved in both eyes. In this paper, the etiology, pathogenesis, epidemiology and treatment of cerebral venous sinus thrombosis is discussed. Cerebral venous sinus thrombosis should be included in the differential diagnosis of bilateral disc edema.The optometrist should be familiar with the different neuroimaging tools used in the diagnosis of cerebral disease since a prompt approach to these patients can save their lives.
Affiliation of Co-Authors Inter American University of Puerto Rico, School of Optometry
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