Complete Superior and Inferior Sagittal Sinus Thromboses With Multiple Cranial Nerve Pareses and Transient Ischemic Attack. Case Report.

Abstract

A 27-year-old woman with headache and right peripheral facial nerve paresis persisting for over 25 days, and left hemiparesis for 2 days, which had all been gradually improving, was admitted to our hospital as she suddenly developed horizontal and vertical diplopia. She had right fourth and sixth cranial nerve pareses, papilledema, and right orbital venous congestion, and also experienced a seizure on the day of admission. Magnetic resonance (MR) imaging and MR venography revealed complete superior and inferior sagittal sinus thromboses and significant collateral venous channels, but no parenchymal lesion. Fourth and seventh cranial nerve pareses and the left hemiparesis resolved completely within 2 days, but she concurrently developed an episode of right hemiparesis, which lasted for 30 minutes. The patient recovered with medical therapy. MR venography showed recanalization of both sinuses. She was neurologically intact except for minimal right abducens nerve paresis at discharge, 40 days after admission. Multiple cranial nerve pareses with transient ischemic attack is an extremely rare manifestation of superior sagittal sinus thrombosis. Transient functional disturbance due to temporary reduction of tissue perfusion caused by overload of the collateral channels is more likely to be responsible for the transient ischemic attack and reversible ischemic neurological deficit.

Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review

“…CVT can also cause multiple cranial nerve paralysis. Topsakal et al ( 2002 ) reported a case of 27-year-old female CVT patient that mainly manifested as multiple cranial nerve paralysis with TIA. She had headaches and right peripheral facial paralysis 25 days before the visit and left peripheral facial paralysis from 2 days before the visit.…”

Nonabducent Cranial Neuropathies in Cerebral Venous Sinus Thrombosis

“…Venous infarcts were not reported. One patient had peripheral VII and trochlear palsy with superior and inferior sagittal sinus thrombosis 22. Among 3 other patients, 1 patient had cranial nerve V and VI21; second had VII and VIII17; and the third patient had VIII, IX, X, and XII cranial nerves affected 20.…”

“…Six patients aged 19 to 72 years, 50% women, presented with other atypical mixed cranial neuropathies other than the involvement of the abducent nerve. 17,[19][20][21][22] Two patients had peripheral VII palsy and oculomotor palsy with thrombosis of TS 17,19 with additional involvement of SSS, and straight sinus in 1 patient. 19 Venous infarcts were not reported.…”

Cerebral Venous Sinus Thrombosis Presenting as Transient Ischemic Attacks in a Case With Homozygous Mutations of MTHFR A1298C and CG677T

“…3 In the other previously reported cases, although no cerebral parenchymal lesions were detected, the authors did not mention EEG findings. [4][5][6] In the present case, the patient's TIAs are not likely due to seizure activity, because brain MRI revealed no evidence of parenchymal lesion that can cause focal epileptic seizures, and, unlike seizures, the symptoms were maximal at onset and nonmarching in nature. 1 In addition, the attacks disappeared with anticoagulant therapy but without concomitant administration of antiepileptic medication.…”

“…1 An extremely rare cause of TIAs is cerebral venous thrombosis (CVT). [2][3][4][5][6] Case Report A 19-year-old, right-handed, previously healthy man presented with headache, double vision, and recurrent attacks of slurred speech, weakness, and numbness of the right half of the face and the right arm. The patient reported experiencing a total of 7 isolated attacks over the last 2 weeks.…”