[Report of a rare manifestation of cerebral venous thrombosis]

ABSTRACT

Straight sinus thrombosis can lead to bilateral thalamus infarct, and if it is not diagnosed on time, death of the patient will ensue. Bilateral thalamus infarct usually presents by loss of consciousness, memory disorders, vertical gaze palsy and psychological disturbances. Our patient was a 28-year old female who had history of fasting for 2 months and prolonged use of contraceptive pills, who referred to emergency department with loss of consciousness, weakness, and a history of severe headache, nausea, vomiting and hypophonic speech from 4 days ago. 10 hours prior to admission she developed disturbances of consciousness. Non contrast computed tomography scan of brain revealed a hyper dense area within the straight sinus and a hyper dense area in the body and posterior horn of right lateral ventricle which was indicative of hemorrhage. MRI and MRV revealed extensive thrombosis in the straight sinus which had led to acute bilateral ischemia in thalami. Anticoagulants, acetazolemide and phenytoin started for the patient for 5 weeks. When she regained her consciousness completely and there was no lateralizing sign, she was discharged from the hospital. Cerebral venous thrombosis can present with protean clinical manifestations in different age groups which may lead to misdiagnosis. Considering history, thinking of this diagnosis and availability of appropriate Para clinical facilities can decrease diagnostic errors