Case of the week:
A healthy female in her teens developed headaches and blurry vision post COVID infection. She went to the ED and was given a Migraine cocktail with temporary improvement.
The headaches persisted and the patient had 4 similar experiences at different EDs.
After a month her blurry vision worsened and was evaluated by an optometrist. She was referred to an ophthalmologist who immediately referred the patient to Neuro-Ophthalmology.
She was found to have severe bilateral disc edema, too elevated to be registered by the OCT!
Visual fields showed incomplete bitemporal hemianopsia with some superior nasal field defects in the left eye.
a CT venogram was obtained STAT and showed as highlighted in red extensive cerebral venous thrombosis with complete occlusion of the superior sagittal sinus, the straight sinus, the vein of Galen, the confluence of sinuses and bilateral transverse sinuses!
She was immediately started on Eliquis and had multiple attempts to clear the thrombosis via interventional catheter procedures with no success.
Eventually due to delays in initial presentation to Neuro-Ophthalmology, and permanent extensive visual field loss, a Ventro-peritoneal shunt was placed with significant improvement of visual fields as seen to the right of the image.
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