Acute Proptosis: A Sign of Venous Hemorrhagic Infarct

Abstract

Acute proptosis is a very rare condition presenting to the emergency department. As there are very few case reports of patients with acute onset proptosis, it is important to report each new case. This case report is of a 38-year-old lady who presented to our emergency department with a headache for three days, altered sensorium for eight hours, and acute proptosis of the left eye for 40 minutes. She was diagnosed to have a venous hemorrhagic infarct in the left parietal-occipital-temporal region with thrombosis of the left transverse and sigmoid sinuses. To the best of our knowledge, there is no documented case report or study which featured acute proptosis as a clinical sign in a patient with venous hemorrhagic infarct or where acute proptosis was associated with thrombosis of a cerebral venous sinus other than cavernous sinus. This study shows that acute proptosis can be a presenting sign even in venous hemorrhagic infarct and acute proptosis can be associated with cerebral sinus venous thrombosis even without the involvement of cavernous sinus. So although rare, venous hemorrhagic infarct and cerebral venous sinus thrombosis irrespective of the venous sinus involved should be considered in any patient presenting to the emergency department with acute onset proptosis.

Keywords: acute proptosis; altered sensorium; cerebral venous sinus thromboses; emergency department; sigmoid venous sinus; transverse venous sinus; venous hemorrhagic infarct.

Figure 1. CT brain scan of the patient shows the proptosis of the left eye. (A) Brain window. (B) Bone window.

Arrows indicate proptosis.

Figure 2. (A) CT brain scan with contrast; arrow indicates the sigmoid sinus thrombosis. (B) Non-contrast CT brain scan; arrow indicates the venous hemorrhagic infarct.

Ventricular bleed and midline shift also seen.