Cranial nerve palsy in cerebral venous sinus thrombosis and response to therapy

Abstract

Clinical presentation of cerebral venous sinus thrombosis (CVST) is variable. The most common symptom of CVST is headache. Cranial nerve palsy in CVST is rare. We present a case of CVST due to oral contraceptive pill usage presented with cranial nerve palsy. A 28 year old female presented with complains of headache and blurring of vision. On further evaluation, we found left 6th cranial nerve palsy with diminished vision on both eyes (left more than right). Initial CT brain imaging was normal. Magnetic resonance venography revealed thrombosis of superior sagittal sinus, right transverse sinus, and right sigmoid sinus extending into the right internal jugular vein. At the end of 6 months of anticoagulation therapy there is marked improvement of vision and complete recovery of left 6th nerve palsy. Though cranial nerve palsy in CVST have been reported previously, new findings of this case is that more sign contralateral to site of lesion and variable response to therapy.