Bilateral Abducens Nerve Palsy Due to Extensive Cerebral Venous Sinus Thrombosis

Abstract

Cerebral venous sinus thrombosis (CVST) is a relatively rare condition. We present a case of an acute aseptic thrombosis of the sagittal, transverse and sigmoid sinus in a puerperium patient with protein S deficiency. The specifics of the case include high intracranial pressure (ICP) caused by sinus thrombosis with typical symptomatology and bilateral papilloedema, which also manifested in transient bilateral abducens nerve palsy and, consequently, bilateral horizontal diplopia. The recovery of the cranial nerve function occurred 3 to 4 weeks after it was initially reported. Prompt and adequate anticoagulant therapy contributed to the almost complete recanalization of the dural venous sinus thrombosis and a positive outcome of the disease.

Unilateral Abducens Nerve Palsy as the Lone Sign of Cerebral Venous Sinus Thrombosis: A Case Report and Literature Review

“…It is possible that the clot directly obstructs the venous drainage of the sixth cranial nerve, leading to ischemia and subsequent nerve dysfunction. Alternatively, the increased intracranial pressure resulting from CVST can indirectly affect the nerve by compressing it against adjacent structures [ 2 ]. In CVST, patients often present with additional neurological symptoms such as headache, seizures, altered mental status, and other cranial nerve palsies, whereas patients with isolated CN VI palsy do not have other neurological symptoms.…”

“…Cerebral venous thrombosis (CVT) is an important cause of ischemia in young patients, caused by complete or partial occlusion of the major cerebral venous sinuses (cerebral venous sinus thrombosis, CVST) or the smaller feeding cortical veins (cortical vein thrombosis) [ 1 ]. CVST is a relatively rare life-threatening condition with variable symptoms depending on the thrombus location, similar to numerous other neurological disorders [ 2 ]. The International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) described the following as the most common presenting symptoms: headache (88.8%), seizures (39.3%), paresis (37.2%), papilledema (28.3%), and mental status changes (22%) [ 3 ].…”

“…Diagnosis is often delayed to a median period of seven days from the onset of clinical manifestations due to the variability of its symptoms [ 4 ]. Global estimation of annual CVST incidence is about three to four cases per million people [ 2 ]. It is more common in women than men (2.2:1) because of the sex‐specific risk of thromboembolism [ 4 ].…”

Cerebral Venous Sinus Thrombosis with Bilateral Abducens Palsy in a Patient with Heterozygous Prothrombin G20210A Mutation

“…Bilateral abducens palsy is rare in CVST, and on literature review has not found any case reports of it in CVST due to prothrombin gene mutation. A case has been described by Buljan et al in puerperium patients with protein S deficiency [5]. Another example was described as a complication of chronic suppurative otitis and mastoiditis.…”

“…Another example was described as a complication of chronic suppurative otitis and mastoiditis. Other causes have been from subarachnoid hemorrhage, Diane syndrome, idiopathic intracranial hypertension, and diabetes [5].…”