ePoster

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Title:

A curious case of a cerebral venous sinus thrombosis (CVST)

Poster Details

First Author: S. Powell IRELAND

Co Author(s):    B. Morris   J. Murray   E. O'Neill              

Abstract Details

Purpose:

A twenty-year old previously healthy male was diagnosed with non-granulomatous bilateral acute anterior uveitis (AAU) after presenting to the Eye Emergency Department (EED) with painful, red, photophobic eyes. Posterior segment examination was unremarkable at the time. He was commenced on topical steroids and cycloplegics tapering over 8 weeks. Baseline uveitis screening and investigations were unremarkable. He represented 4 weeks later with a 3-week history of a progressively worsening headache associated with nausea and vomiting. The headache was generalized & constant involving right temporal, frontal and occipital areas with associated lethargy and fatigue, and new onset nausea and vomiting that day

Setting:

EED - Mater Misericordiae University Hospital, Dublin

Methods:

Visual acuity was 6/6 in both eyes. Examination of the anterior chambers bilaterally was unremarkable. Posterior segment examination revealed bilateral prominent optic nerves with significantly blurred disc margins. An urgent non-contrast Computed Topography (CT) of the head and orbits demonstrated a hyperdense linear opacity in the straight sinus which was concerning for cerebral venous sinus thrombosis (CVST). Magnetic Resonance (MR) venogram showed a filling defect in the straight sinus with further filling defect in the right sigmoid sinus with thrombus seen extending to almost the right jugular bulb, thus confirming the diagnosis of CVST. ﾠ

Results:

On further questioning, the patient had a long-standing history of intermittent oral and genital ulceration. Based on the International BD Study group criteria, this patient was diagnosed with a CVST secondary to Behcetﾒs Disease. The patient was commenced on a therapeutic dose of enoxaparin and prednisolone 40mg OD. On discharge, he remained on enoxaparin therapeutically, warfarin as per International Normalised Ratio (INR), a tapering dose of prednisolone 40mg OD and commenced on azathioprine 100mg BD. ﾠ

Conclusions:

We present a rare case of CVST secondary to NBD in a twenty-year old Caucasian Irish male with no family history of BD. BD is a rare disease in Ireland, and this presentation of NBD in a patient with undiagnosed BD is extremely unusual. CVST secondary to NBD normally presents in a subacute clinical manner, whereby a severe, progressive headache over the course of a number of weeks is the most common clinical feature on presentation.Although a rare disease in Ireland, BD is an important differential diagnosis in a young patient with CVST or a young patient with bilateral AAU.

Financial Disclosure:

None