Visual System Manifestations of Cerebral Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is a rare and potentially life-threatening cause of stroke with varied presentation. Ocular signs and symptoms can be the main presenting findings. In this retrospective cohort study, we examine the ophthalmic manifestations of CVST in 52 patients. Charts from a total of 70 patients were reviewed. For inclusion, a patient must have had radiologic evidence of CVST at the time of ophthalmic examination. We identified 20 cases of sagittal sinus thrombosis, 9 cases of cavernous sinus thrombosis, 8 cases of transverse sinus thrombosis, 1 case of bilateral sigmoid sinus thrombosis, and 14 cases of thrombosis of multiple dural venous sinuses, termed “complex” venous sinus thrombosis. Headache was the most common presenting symptom. With respect to cranial nerve palsies, abducens nerve palsy was the most common and present in 20 patients (38%). Other cranial nerve palsies were seen nearly exclusively in cavernous sinus thrombosis. Optic disc edema was not a key feature of cavernous sinus thrombosis in this cohort, and was much more commonly seen in sagittal, transverse, and complex venous sinus thrombosis. Nearly all patients had visual field defects, with the arcuate pattern as the most common defect.