Bilateral Proptosis: Unusual presentation of Cortical Sinus Thrombosis.

摘要

We report a rare presentation of Cortical Sinus venous thrombosis. This case presented with bilateral proptosis in an adult female. CT scan of brain showed left cavernous sinus and bilateral superior ophthalmic vein thrombosis with Right subdural hematoma (9cm x1.5cm). Introduction Thrombosis of the cortical veins and sinuses is a distinct Cerebrovascular disorder that, unlike arterial stroke, most often affects young adults and children. The symptoms and clinical course are highly variable. The estimated annual incidence is 3 to 4 cases per 1 million population and up to 7 cases per 1 million among children. About 75 percent of the adult patients are women [1]. During the past decade, increased awareness of the diagnosis, improved neuroimaging techniques, and more effective treatment have improved the prognosis. More than two third of all patients now have a good neurologic outcome [2]. We present here, a case of a 30 years young female who presented with history of headaches and bilateral Proptosis. Case Summary A 30 year old female presented to the emergency department of the hospital with diffuse headache and bilateral proptosis, which was associated with vomiting. On examination she was conscious, oriented, but anxious. She also had low grade fever. There was no history of ear discharge, cough, or burning micturition. She was normotensive and nondiabetic. There was no history suggestive of seizures. No past history suggestive of convulsions, tuberculosis. She is P2L2A0 and the previous deliveries were normal without any complicating events. General physical examination suggested pulse was 100/min and regular. Her blood pressure at the time of admission was 120/70 mmHg in left upper limb supine position. She was pale and anicteric. On CNS examination, patient had bilateral proptosis with restricted Left Eye movement (III nerve palsy). There was also associated chemosis and corneal haziness (Due to Exposure of cornea). Papilloedema was also present in fundi of both eyes. All other cranial nerves were normal. There was no any other neurological deficit. Deep tendon reflexes preserved and plantars were flexors. Her investigations revealed hemoglobin was 10.5 gm/dl, total leukocyte counts were 15,000 per cubic mm. Platelets were normal. There was no sickle cell on peripheral smear. Anti phospholipids antibody was normal. Her chest film was normal. Patient underwent CT scan head –both without and with contrast study. CT scan showed left cavernous sinus thrombosis extending to bilateral superior ophthalmic vein thrombosis [Fig-1]. There was also right subdural hematoma [Fig-2]. On the basis of this CT scan findings and clinical feature we treated the patient with I.V. mannitol, higher antibiotics and corticosteroids. Patient did not show any improvement. She died on subsequent day.