Cerebral Venous Thrombosis Presenting as Optic Neuropathy: A Case Report

Abstract

Background: Cerebral Venous Thrombosis (CVT) is an uncommon cerebrovascular disorder with a highly variable clinical spectrum. While headache is the most prevalent symptom, acute and severe visual impairment as the dominant presenting feature is rare and constitutes a neuro-ophthalmic emergency. Case Presentation: We report the case of a 63-year-old male with a chronic smoking history who presented with sudden-onset, progressive visual deterioration over three days, culminating in complete bilateral vision loss, accompanied by headache. An ophthalmology consultation revealed bilateral disc hyperemia. Neuroimaging, including Magnetic Resonance Imaging (MRI) and MR Venography, confirmed partial thrombosis involving the venous sinus confluence, posterior superior sagittal sinus, right transverse and sigmoid sinuses, and the right proximal internal jugular vein. The patient was managed with systemic anticoagulation and a course of high-dose corticosteroids for suspected compressive optic neuropathy. Clinical stabilization was achieved, and he was discharged on warfarin and a tapering dose of prednisolone. Discussion: This case details an atypical manifestation of CVT. The pathophysiology of acute visual failure likely involves compressive optic neuropathy, corroborated by the ophthalmoscopic finding of bilateral disc hyperemia, and possible venous congestion of the optic nerves. Management necessitates a dual strategy: immediate anticoagulation to arrest thrombus propagation and corticosteroids to mitigate secondary optic nerve insult. Conclusion: CVT should be considered in the differential diagnosis of acute, profound vision loss, particularly when accompanied by headache. Prompt diagnosis via MR Venography and expeditious, targeted intervention are critical to optimize neurological outcomes.