Diplopia and papilledema secondary to thrombosis of the longitudinal venous sinus due to Leiden factor V thrombophilia in a young patient.
J Dalma-Weiszhausz, V Franco-Cárdenas, J P Dávila-González
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Case in brief
A five-year-old girl presented with acute irritability, somnolence, headache, and diplopia. Examination showed preserved vision, marked esotropia with a sixth-nerve palsy, and papilledema. MRI demonstrated longitudinal venous sinus thrombosis; testing identified factor V Leiden thrombophilia, and an asymptomatic pulmonary thrombosis was also found. After anticoagulant therapy, the diplopia and optic-disc edema resolved, although MRI continued to show sinus thrombosis.
What made this case unusual
The presentation combined raised intracranial pressure signs with an asymptomatic pulmonary thrombosis in a young child with factor V Leiden thrombophilia.
Diagnostic / clinical pearl
In a child with papilledema and sixth-nerve palsy, consider cerebral venous sinus thrombosis as a cause of cranial hypertension, even when vision is preserved.