Acute bilateral vision loss secondary to cerebral venous thrombosis-induced intracranial hypertension: a case report.

Abstract

Background: The present case describes a rare presentation of sudden onset acute bilateral vision loss due to cerebral venous thrombosis secondary to malignant rise in intracranial pressure.

Case presentation: A 23-year-old male patient presented with sudden onset bilateral loss of vision of one week duration. Best-corrected visual acuity was 6/18, N12, and perception of light in the right and left eye, respectively. Fundus examination revealed papilledema. Magnetic resonance imaging showed thrombotic occlusion of the superior sagittal, straight, and inferior sagittal sinuses. Cerebrospinal fluid opening pressure was elevated to 40 cm H₂O. Laboratory investigations showed the presence of polycythemia (Hemoglobin- 18.6 g/dl) and elevated serum homocysteine (38.64 µmol/L) levels. Early initiation of appropriate treatment resulted in improvement of vision to 6/9, N8 and 6/6, N6 in the right and left eye, respectively. One month following treatment, there was complete resolution of papilledema and retinal haemorrhages in both eyes.

Conclusion: Malignant rise in intracranial pressure can rarely lead to the sudden onset bilateral vision loss. Early diagnosis and prompt treatment can be associated with a good visual prognosis.