Recurrent Cerebral Venous Sinus Thrombosis Masking as Acute Cranial Neuropathy with Delayed Papilledema and Contralateral Cavernous Relapse: A Case Report
DOI:
https://doi.org/10.37275/oaijmr.v6i5.945Keywords:
Cavernous sinus syndrome, Cerebral venous sinus thrombosis, Delayed papilledema, Digital subtraction angiography, Oculomotor palsyAbstract
Background: Cerebral venous sinus thrombosis (CVST) may initially resemble isolated cranial neuropathy; papilledema can appear later.
Objective: To describe the 30-month neuro-ophthalmic course, imaging findings, treatment and contralateral relapse in one patient.
Methods: A 26-year-old man treated from December 2023 to June 2026 underwent serial visual acuity, pupillary, spectral-domain optical coherence tomography (SD-OCT), 24-2 perimetry, MRI/MRV and digital subtraction angiography (DSA) assessments.
Result: He first presented with pupil-involving left oculomotor palsy and headache despite initially unrevealing CT and MRI/MRA. Ten months later, MRI suggested right sigmoid sinus thrombosis with left transverse-sigmoid sinus hypoplasia; DSA confirmed CVST. Four weeks after anticoagulation began, bilateral Frisén grade 5 papilledema developed (peak retinal nerve fiber layer thickness 412 μm OD and 445 μm OS; visual acuity 6/19 OU). Rivaroxaban, pulse methylprednisolone and acetazolamide were followed by complete recanalization, 70.5% regression of retinal nerve fiber layer edema and restoration of 6/6 acuity in both eyes. At month 28, right cavernous pachymeningitis occurred without sinus re-thrombosis and responded to corticosteroids.
Conclusion: CVST can present as isolated oculomotor palsy before papilledema. DSA can resolve discordant noninvasive imaging, and prolonged follow-up can identify inflammatory relapse.
Authors
- Maria Yovita Saraswati Pele Alu1
- Anak Agung Mas Putrawati Triningrat1*
- Nyoman Angga Krishna2
- I Gusti Ayu Made Juliari2
- 1Department of Ophthalmology, Faculty of Medicine, Universitas Udayana / Prof. Ngoerah General Hospital, Denpasar, Indonesia
- 2Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Corresponding author Anak Agung Mas Putrawati Triningrat — masputra@unud.ac.id
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Copyright (c) 2026 Maria Yovita Saraswati Pele Alu, Anak Agung Mas Putrawati Triningrat, Nyoman Angga Krishna, I Gusti Ayu Made Juliari
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