Cortical blindness as a rare presentation of cerebral venous thrombosis
An 18-year-old female with a three-week history of headaches presented with an acute onset of blindness in both eyes after her afternoon nap. Physical examination demonstrated normal pupils and funduscopic exam, but without light perception in either eye. Cranial nerve examinations were otherwise unremarkable. Speech was intact with no naming or repetition deficits. Although alert, she was mildly confused. No isolated motor or sensory deficits were identified in the extremities. Deep tendon reflexes were 3+ in the upper extremities and 4+ in the lower extremities. No ankle clonus was noted, and plantar reflexes were equivocal.\nCranial computed tomography (CT) demonstrated subtle hypodensity mainly in the left occipital lobe, with a characteristic empty delta sign (Fig. ). Computed tomography angiography demonstrated normal filling of the posterior cerebral arteries (PCA). Cranial magnetic resonance imaging (MRI) evaluations demonstrated bilateral ischemic changes involving the occipital and parietal lobes, more extensively on the left (Fig. ). Magnetic resonance venography (MRV) demonstrated complete occlusion of the left transverse and sigmoid sinuses, as well as near occlusion of the posterior superior sagittal sinus (Fig. C).\nThe patient was treated emergently with endovascular mechanical thrombolysis with technical success (Fig. A and B), followed by systemic anticoagulation therapy. Post-intervention MRV demonstrated persistent recanalization of the left transverse and sigmoid sinuses, along with much improved flow in the posterior superior sagittal sinus (Fig. D).\nShe was subsequently diagnosed with mixed connective tissue disease. Clinically, she recovered the left visual field but continued to have a dense right homonymous hemianopsia at discharge. She returned to her home state and was unfortunately lost to further follow-up.