Unilateral Exophthalmia Revealing Postpartum Thrombophlebitis

Abstract

Introduction: Cerebral thrombophlebitis of the peripartum is a rare entity but its occurrence is serious and can compromise the vital prognosis. The clinical picture is variable, which makes early diagnosis difficult. Patients and Methods: We report the case of a 28-year-old patient, on oral contraception for 3 years, with no previous history; who presented rapidly progressive bilateral visual acuity loss associated with headaches. The examination revealed a painless exophamia of the left eye without motor deficit, a slight chemosis with subconjunctival venous vasodilatation, associated with a bilateral papillary edema confirmed by OCT. CT scan showing a cerebral thrombophlebitis of the superior longitudinal sinus extended to the jugular vein with slight cerebral edema. The patient was immediately admitted to the intensive care unit and put on heparin therapy and additional immunological tests. Discussion: Pregnancy and postpartum increases the risk of thrombotic events. The most common cause in women of childbearing age is hypercoagulability, associated with the postpartum period, pregnancy, or oral contraceptives which is the case of our patient. Clinical symptoms are very polymorphic. The main thing is to think about it in order to make an early diagnosis. The positive diagnosis is neuroradiological. Improved diagnostic methods and consequent earlier treatment have markedly improved the prognosis of CVT in recent year. Conclusion: Postpartum cerebral venous thrombosis is a rare but serious pathology. The clinical diagnosis is not easy because of the clinical polymorphism, it is necessary to know how to think about it even in front of purely ophthalmological signs and to ask for neuro-radiological examinations to confirm it. The prognosis remains good if the diagnosis is made in time and if the treatment is started early.