Cerebral Venous Sinus Thrombosis with Bilateral Abducens Palsy in a Patient with Heterozygous Prothrombin G20210A Mutation

Abstract

We present a rare case of cerebral venous thrombosis in a patient with heterozygous mutation of the prothrombin G20210A gene. A 24-year-old Caucasian male complained of sudden onset diplopia due to bilateral abducens palsy and throbbing headache with pulsatile tinnitus. Computed tomography revealed extensive thrombus in the right sigmoid sinus, right transverse sinus, and the superior sagittal sinus. Except for the prothrombin mutation, no other predisposing risk factors were found. The patient was treated with heparin, later transitioned to enoxaparin and warfarin, and subsequently, the symptoms improved on follow-up. This case reveals the rare occurrence of cerebral venous thrombosis in a patient having prothrombin gene G20210A mutation alone. Early diagnosis and treatment can lead to a good prognosis.

Keywords: anti-coagulation therapy; bilateral abducens nerve palsy; cerebral sinus thrombosis; cerebral sinus venous thrombosis (csvt); diplopia; headache; prothrombin g20210a gene; prothrombin gene mutation.