Cerebral Venous Thrombosis with Grade II Papilledema Associated with Polycythemia, Grade II Hypertensive Retinopathy, and Left-Ear Granular Myringitis: A Case Report

Abstract

Background: Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular disorder that may present with headache and visual disturbances. Elevated haematological parameters can coexist with CVT and warrant careful assessment. Case Presentation: A 40-year-old man with a six-month history of hypertension and irregular medication use presented with headache, approximately 10 episodes of vomiting, blurred vision, intermittent diplopia, giddiness and generalised weakness. His blood pressure was 148/90 mmHg. Ophthalmological examination identified grade II papilloedema and grade II hypertensive retinopathy. Laboratory investigations showed a haemoglobin concentration of 18.6 g/dL and a haematocrit of 55.8%, indicating erythrocytosis. Contrast magnetic resonance imaging and venography demonstrated acute thrombosis involving the superior sagittal sinus, bilateral transverse and sigmoid sinuses, torcular Herophili and superficial cortical veins, with extension into the left proximal internal jugular vein. No acute infarct or intraparenchymal haemorrhage was reported. During hospitalisation, left-ear discharge developed, and suspected granular myringitis was managed with topical preparations. Treatment included heparin followed by dabigatran, antiplatelet therapy, antihypertensive medication, measures for raised intracranial pressure, supportive care and phlebotomy. The patient's symptoms improved during hospitalisation, and he was discharged in a stable condition on oral anticoagulation. Conclusion: This report describes concurrent neurological, ophthalmological, haematological and otological findings in a patient with extensive CVT, highlighting the importance of timely venographic imaging and coordinated clinical assessment.