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.

Keywords: abducens palsy; cerebral venous sinus thrombosis; papilloedema; protein S deficiency.

Figure 1

(A) Computed tomography of the head shows acute thrombosis of the right transverse sinus (arrow), the right sigmoid sinus (arrowhead) and the sagittal sinus (filled arrow). (B) Magnetic resonance venography confirmed the absence of flow in the right transverse, right sigmoid and sagittal sinuses (arrows) as a consequence of thrombosis. R = right.

Figure 2

Patient with bilateral abducens palsy due to extensive cerebral venous sinus thrombosis. Images show inability of (A) the left eye to turn out in left gaze and (B) the right eye to turn out in right gaze. (C) Bilateral abducens palsy was confirmed by the Hess–Lancaster test.

Figure 3

Follow-up magnetic resonance venography (18 days after the initial one) revealed partial recanalization of cerebral venous sinuses thrombosis; (A) sigmoid (arrow) and transverse (filled arrow); (B) sagittal (arrow) and transverse (filled arrow).

Figure 4

Follow-up magnetic resonance venography (3.5 months after the initial one) indicated further significant regression of the cerebral venous sinus thrombosis (arrows).