Bilateral optic disc swelling as a presenting sign of superior sagittal sinus thrombosis

Abstract

The case of a 59-year-old Caucasian man who presented with a 6-week history of intermittent blurring of vision and diplopia is reported. Fundoscopy revealed asymmetrical, bilateral optic disc swelling with peripapillary haemorrhages. An initial CT scan and D-dimer level were reported as normal. A subsequent MRI revealed a recanalising superior sagittal sinus thrombosis. Cerebral venous sinus thrombosis is a rare and potentially fatal condition. The author suggests that it should be part of the differential diagnosis of bilateral optic disc swelling and that a normal unenhanced CT scan and D-dimer would not rule out this potentially devastating condition.

Figure 1

Fundus photographs showing bilateral optic disc swelling with peripapillary haemorrhages.

Figure 2

Axial T2 MRI scan of the brain demonstrating hyperintensity within the superior sagittal sinus (SSS), suggesting thrombosis. Note the small, hypointense focus at the anterior aspect of the SSS reflecting partial recanalisation.

Figure 3

Three-dimensional magnetic resonance venography showing prominent flow within cortical veins due to shunting to alternative venous drainage pathways.