Abstract
IntroductionA 59-year-old Caucasian woman presented with an acute onset of alexia, noticed whilst driving. She described how while she could read car number plates, she had lost the ability to read and understand words on roadside advertisements and car window stickers.Case presentationNeurological examination was unremarkable apart from the inability to read full words or sentences. Imaging of the brain, initially computed tomography, followed by magnetic resonance venography, confirmed a diagnosis of sigmoid sinus thrombosis with associated venous infarction. The patient's past medical history revealed that she had suffered an ischemic stroke and following investigation for this, had undergone a nephrectomy for renal cell carcinoma. This was complicated by postoperative deep venous thrombosis. She had a persistent polycythaemia that was managed with venesection, and recently she had been diagnosed with Behçet's disease. Prior to this presentation, she had recently stopped her prophylactic antiplatelet medication as she was due to undergo a total knee replacement for osteoarthritis. She was managed with weight-adjusted, low molecular weight heparin followed by oral anticoagulation, and made a good recovery from her symptoms.ConclusionThis case illustrates a classical neurological syndrome, highlights the importance of cerebral venous and sinus thrombosis as a cause of stroke, and the importance of remaining vigilant to a person's changing risk of venous thrombosis with evolving comorbidity.
Highlights
A 59-year-old Caucasian woman presented with an acute onset of alexia, noticed whilst driving
We describe a patient with posterior alexia secondary to sigmoid sinus thrombosis who had multiple independent risk factors for venous thrombosis prior to this stroke
A key issue is the differentiation of cerebral venous infarction with secondary haemorrhage from other causes of intracerebral haemorrhage including haemorrhagic transformation of ischaemic infarction or primary intracerebral haemorrhage: a cursory inspection of the computed tomography (CT) may lead to misdiagnosis and subsequent mismanagement of the underlying cause of the stroke
Summary
This case report demonstrates an unusual presentation of a classical neurological disorder. In terms of the history and background of the case, we highlight the potential for people to develop a combination of thrombophilic states that act to increase significantly their risk of venous thrombosis. On review of the literature, we have found no reported cases with the same permutation of risk factors as our patient. It is difficult, to predict accurately http://www.jmedicalcasereports.com/content/2/1/175 her risk of thrombosis; these factors need to be appreciated in routine presurgical assessment clinics and at routine clinical review in order to optimally manage this risk. CT: computed tomography; CVST: cerebral venous and sinus thrombosis; DVT: deep venous thrombosis
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