Images in Clinical Medicine

Cerebral Venous Thrombosis

Pierre-Marie Roy, M.D., and Emmanuelle Gras, M.D.

N Engl J Med 2003; 349:1730October 30, 2003

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Article

A 20-year-old, previously healthy woman presented with a progressively worsening headache. She had been well until three weeks earlier, when she started having an episodic, pulsating headache. Migraine was suspected, and treatment with a triptan and acetaminophen was transiently effective. For about a week, the headache worsened, with nausea, vomiting, photophobia, and for two days, blurred vision. The patient smoked and took oral contraceptives. Examination disclosed left orbital ecchymosis (Panel A), paralysis of the left abducens nerve, and bilateral papilledema with venous congestion. Magnetic resonance imaging coupled with magnetic resonance angiography confirmed the presence of cerebral venous thrombosis with involvement of the superior longitudinal sinus (Panel B, arrows). A test for thrombophilia was negative. The patient was given anticoagulant treatment and stopped taking oral contraceptives. Six months later, a mild abduction deficit in her left eye persisted.

Pierre-Marie Roy, M.D.
Emmanuelle Gras, M.D.
Angers University Hospital, 49033 Angers, France