Recurrent Cerebral Venous Sinus Thrombosis Presenting with Isolated Visual Symptoms: A Case Report.

INTRODUCTION

Cerebral venous sinus thrombosis is a rare but potentially life-threatening cerebrovascular disorder caused by thrombosis of the dural venous sinuses. Clinical manifestations are highly variable and often nonspecific, which may lead to delayed diagnosis. Although headache and focal neurological deficits are common, isolated visual symptoms are uncommon and frequently overlooked. Women of reproductive age are at increased risk due to hormonal and prothrombotic factors such as pregnancy, the postpartum period, assisted reproductive technologies, and endocrine disorders including polycystic ovary syndrome.

CASE PRESENTATION: A 29-year-old woman with polycystic ovary syndrome and primary infertility previously developed cerebral venous sinus thrombosis involving the superior sagittal sinus and right transverse sinus after cesarean delivery following in vitro fertilization. Approximately 1 month after documented radiological recanalization, she represented with recurrent thrombosis; 2 months later, she developed sudden bilateral blurred vision and left-sided floaters. Magnetic resonance imaging with magnetic resonance venography demonstrated recurrent partial thrombosis of the superior sagittal sinus associated with a brief 1-week interruption of anticoagulation therapy. Automated perimetry showed a Glaucoma Hemifield Test within normal limits in the left eye (visual field index: 99%, mean deviation: +0.22 dB) with a superonasal pattern deviation cluster and significant pattern standard deviation (1.94 dB, p < 5%); test reliability was limited by elevated false-positive errors and repeat perimetry was planned. The blurred vision was attributed to transient intracranial venous hypertension without papilledema.

CONCLUSION

Recurrent cerebral venous sinus thrombosis may present with isolated visual symptoms. Early neuroimaging and uninterrupted anticoagulation are essential to prevent recurrence and reduce morbidity.