Eyelid oedema and headache

Abstract

upper eyelids (figure, A, arrows). She was seen by doctors who applied topical mydriatic drops, and examined her eyes thoroughly, but found nothing unusual, and made a working diagnosis of an allergic reaction. 3 days later, the patient developed a headache and consulted an orthopaedic specialist and a practitioner of alternative medicine, neither of whom made a specific diagnosis. On day 6, she presented to our hospital. Her medical history was unremarkable and she was not prone to headaches. Blood pressure, body temperature, and routine blood tests were in the normal range. The patient had a body mass index of 32·2. We did a neurological examination and found slightly exaggerated left-sided tendon jerks. A contrastenhanced angio-CT showed thrombosis of the sagittal superior sinus and both transverse sinuses (figure, B, arrows). We diagnosed an aseptic cerebral venous thrombosis, and gave her intravenous heparin. The eyelid oedema decreased the following day (figure, C) and a second ophthalmic examination showed bilateral papilloedema (figure, D). Tests for thrombophilia were negative. Following 6 months of oral anticoagulation, the veins partially recanalised. Eyelid oedema is a typical finding in cases of septic thrombosis of the cavernous sinus, but can also occur with aseptic thrombosis of the sagittal sinus. The venous drainage from the eyelids via the venae ophthalmicae into the cavernous sinus is probably impaired by elevated intracranial pressure as well as by the compensatory elevated flow in the emissary veins, through the diploe into the veins of the forehead. In this case the eyelid oedema preceded the more common symptoms of cerebral venous thrombosis—namely headache, neurological signs, and papilloedema, by a few days. Clinical Picture