Abstract
Cerebral venous sinus thrombosis (CVST) has a range of underlying cause. Here a case of CVST with an uncommon etiology is presented and discussed. A 40-year-old female presented with headache for 2 years and progressive visual loss for 4 months. She had conjunctival congestion and bilateral papilloedema with pale disc on right side. Computed tomography (CT) scans and contrast magnetic resonance imaging (MRI) of brain were normal but venography (MRV) revealed widespread thrombosis of dural sinuses including superior sagittal sinus. Cerebrospianal fluid (CSF) pressure was high (360 mm of H<sub>2</sub>O) while other CSF parameters were normal. She was polycythemic (hemoglobin 18.1 g/dl, hematocrit 60.2%), Bone marrow study revealed pan-myeloid hyperplasia whereas trephine biopsy revealed hypercellular marrow with trilineage expansion suggestive of myeloproliferative disorder possibly polycythemia vera. JAK-2 mutation was also detected. CVST has different patterns of presentations including isolated intracranial hypertension leading to visual loss. It is essential to identify and treat underlying condition like polycythemia vera.
Highlights
In ‘Cerebral venous sinus thrombosis’ (CVST) the process of thrombosis affects the venous side of the brain circulation and leads to occlusion of one or more dural venous sinuses [1]
It was experienced that CVST was the cause of admission to the neurology department of the National Institute of Neurosciences, Dhaka, Bangladesh in 0.9% (53 out of 5752) and 1.3% (79 out of 6162) patients during 2017 and 2018 respectively
A 40-year-old female was admitted in neurology department of National Institute of Neurosciences and hospital for evaluation of headache and visual loss
Summary
In ‘Cerebral venous sinus thrombosis’ (CVST) the process of thrombosis affects the venous side of the brain circulation and leads to occlusion of one or more dural venous sinuses [1]. The incidence of CVST is estimated to be 1.32 per 100 thousand populations per year in developed countries [2]. The incidence may be higher in developing countries. It was experienced that CVST was the cause of admission to the neurology department of the National Institute of Neurosciences, Dhaka, Bangladesh in 0.9% (53 out of 5752) and 1.3% (79 out of 6162) patients during 2017 and 2018 respectively. Common risk factors of CVST are pregnancy, puerperium, infections, dehydration and prothrombotic drugs like oral contraceptive pills. Risk factors like genetic thrombophilic diseases, antiphospholipid syndrome and myeloproliferative syndromes are relatively rare but important to identify and manage [3]. A case of CVST with an uncommon etiology is presented and discussed
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