A 22-year-old woman with a history of
oral contraceptive use developed right-sided
headache, blurred vision, and
dizziness for 4 days. Magnetic resonance venogram showed complete
thrombosis of the right transverse sinus, sigmoid sinus, and internal jugular vein, and partial
thrombosis of the superior sagittal sinus, left transverse sinus, and superior part of the left internal jugular vein. Hypercoagulable workup revealed heterozygous
factor V Leiden mutation. About 2 weeks after symptom onset, she developed right facial droop and left eye ptosis. Examination revealed bilateral
papilledema, partial left ptosis, complete right abducent, and right peripheral
facial palsies.
Acetazolamide 250 mg 2 times per day was initiated for the treatment of
headache. Three days after starting
acetazolamide left ptosis, right facial and abducent
palsies improved that continued to get better with only slight deficits at discharge 4 weeks from symptom onset. Follow-up computed tomography venogram on day 24 showed partial recanalization of CVST.
CONCLUSION: