Cerebral Venous Sinus Thrombosis with Bilateral Abducens Palsy in a Patient with Heterozygous Prothrombin G20210A Mutation

Nitrous oxide (NO) is an inhalant that has become increasingly popular as a recreational drug. While it is presumed to be harmless, a number of adverse effects of NO have been described. We discuss the case of a 24-year-old man with no medical history, who initially presented to the emergency department with progressive polyneuropathy caused by vitamin B12 deficiency after NO abuse. Two days after being discharged with hydroxocobalamin supplementation, the patient returned with a severe headache, blurry vision and slurred speech. Imaging revealed cerebral venous sinus thrombosis. Hypercoagulability workup showed slightly elevated homocysteine and normalised vitamin B12 after supplementation. Genetic testing showed a heterozygous prothrombin G20210A mutation. He was treated with low-molecular-weight heparin followed by dabigatran. We hypothesise that NO use may increase the risk of developing cerebral venous thrombosis, especially in patients with multiple risk factors and elevated homocysteine levels.

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Cerebral venous sinus thrombosis as a recurrent thrombotic event in a patient with heterozygous prothrombin G20210A genotype after discontinuation of oral anticoagulation therapy: How long should we treat these patients with warfarin?

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-006-0005-5 ◽

2007 ◽

Vol 24 (1) ◽

pp. 77-80 ◽

Cited By ~ 4

Author(s):

Ivana Jukic ◽

Marina Titlic ◽

Ante Tonkic ◽

Daniel Rosenzweig

Keyword(s):

Oral Anticoagulation ◽

Sinus Thrombosis ◽

Thrombotic Event ◽

Anticoagulation Therapy ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Prothrombin G20210a ◽

Oral Anticoagulation Therapy ◽

Venous Sinus Thrombosis

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Bilateral Abducens Nerve Palsy Due to Extensive Cerebral Venous Sinus Thrombosis

Medicina ◽

10.3390/medicina55040115 ◽

2019 ◽

Vol 55 (4) ◽

pp. 115

Author(s):

Buljan ◽

Šarić ◽

Czersky Hafner ◽

Perković

Keyword(s):

Nerve Palsy ◽

Sinus Thrombosis ◽

Rare Condition ◽

Abducens Nerve ◽

Positive Outcome ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Abducens Nerve Palsy ◽

Venous Sinus Thrombosis ◽

Bilateral Abducens

Cerebral venous sinus thrombosis (CVST) is a relatively rare condition. We present a case of an acute aseptic thrombosis of the sagittal, transverse and sigmoid sinus in a puerperium patient with protein S deficiency. The specifics of the case include high intracranial pressure (ICP) caused by sinus thrombosis with typical symptomatology and bilateral papilloedema, which also manifested in transient bilateral abducens nerve palsy and, consequently, bilateral horizontal diplopia. The recovery of the cranial nerve function occurred 3 to 4 weeks after it was initially reported. Prompt and adequate anticoagulant therapy contributed to the almost complete recanalization of the dural venous sinus thrombosis and a positive outcome of the disease.

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