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Table of Contents
Year : 2022  |  Volume : 10  |  Issue : 3  |  Page : 217-218

Cerebral venous sinus thrombosis with lower motor neuron facial palsy

Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil

Date of Submission21-Dec-2021
Date of Acceptance29-Dec-2021
Date of Web Publication12-Jul-2022

Correspondence Address:
Dr. Jamir Pitton Rissardo
Av. Roraima, 1000 - Camobi, Santa Maria – RS 97105-900
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajim.ajim_131_21

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How to cite this article:
Rissardo JP, Caprara AL. Cerebral venous sinus thrombosis with lower motor neuron facial palsy. APIK J Int Med 2022;10:217-8

How to cite this URL:
Rissardo JP, Caprara AL. Cerebral venous sinus thrombosis with lower motor neuron facial palsy. APIK J Int Med [serial online] 2022 [cited 2022 Sep 26];10:217-8. Available from: https://www.ajim.in/text.asp?2022/10/3/217/350744

Dear Editor,

Cerebral venous sinus thrombosis can have a variety of clinical manifestations. However, most frequently presents with headache, nausea, and vomiting. Cranial nerve involvement is common and mainly occurs with the sixth nerve due to raised intracranial pressure. On the other hand, palsies of other cranial nerves were rarely reported in association with sinus thrombosis.

Herein, we would like to discuss cerebral venous sinus thrombosis with facial nerve involvement [[Figure 1] and Other 1 Supplementary Material].[1],[2],[3],[4],[5] A literature search was performed in Medline using a set of terms that included cerebral venous sinus thrombosis, venous sinus thrombosis, and facial [Other 2 Supplementary Material].
Figure 1: Schematic diagram of cerebral venous sinus thrombosis with facial nerve involvement. Internal acoustic meatus; middle cranial fossa; optic canal; posterior cranial fossa; foramina rotundum and ovale; superior orbital fissure; VII, facial nerve (seventh cranial nerve)

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There are only a few cases of isolated unilateral facial nerve palsy due to sinus thrombosis. To the authors' knowledge, only three case reports were already published.[2],[3],[4] In 1993, Dickins and Graham described an adult female who developed unilateral facial weakness, which was diagnosed with Bell's palsy. After 10 days, the subject complained of headaches, vomiting, and dizziness. A brain magnetic resonance image was requested and showed right transverse sinus, sigmoid sinus, internal jugular vein, and sagittal sinus thrombosis.[2]

In 2000, Straub et al. reported a similar case to that described by Dickins and Graham, in which they depicted an individual with facial weakness and photophobia. Neuroimaging revealed extensive sinus thrombosis throughout the bilateral internal cerebral vein, vein of Galen, straight sinus, superior sagittal sinus, left transverse sinus and sigmoid sinus, and the junction of right transverse sinus and sigmoid sinus. The management was anticoagulation and the patient had a full recovery of facial movements after 30 days.[3]

The most recent case was published by Kulkarni et al. in 2013. Their patient was a 30-year-old female with congenital deaf-mutism. She complained of abnormal facial movements and headaches. Thrombosis of superior sagittal sinus, transverse sinus, and sigmoid sinus was noted.[4]

The three cases reported of isolated unilateral facial nerve palsy due to sinus thrombosis were young-adult females who had a diagnosis of cerebral venous sinus thrombosis within 3 weeks of symptoms onset. Anticoagulation was attempted in two cases, in which a complete recovery was achieved. One individual received acetylsalicylic acid and her follow-up was not clearly described. The occurrence of sinus thrombosis was associated with oral contraceptives in two cases, but the patient reported by Straub et al. also had familial protein S deficiency.

Shah and Sardana mentioned that bilateral facial nerve involvement was not reported in cerebral venous sinus thrombosis. However, Shariff and Alhameed published on the “Oxford Medical Case Reports” a young-adult male who had a whiplash neck injury and after 4 days, presented with headaches, blurred vision, and neck pain.[5] On the neurological examination, right facial palsy was noted. After 2 days, he also developed left lower motor neuron palsy. Therefore, Shariff and Alhameed were probably the first to document the relationship between bilateral facial nerves and cerebral venous thrombosis.

It is worthy of mentioning that the Shariff and Alhameed case neuroimaging showed progressive extensive thrombosis throughout the days. Nevertheless, the subject fully recovered from bilateral facial and oculomotor weakness.

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  References Top

Shah V, Sardana V. A case of bilateral lower motor neuron facial palsy in cerebral venous sinus thrombosis. APIK J Int Med 2021;9:189-91.  Back to cited text no. 1
  [Full text]  
Dickins JR, Graham SS. Neurotologic presentation of sagittal sinus thromboses associated with oral contraceptive usage. Am J Otol 1993;14:544-7.  Back to cited text no. 2
Straub J, Magistris MR, Delavelle J, Landis T. Facial palsy in cerebral venous thrombosis: Transcranial stimulation and pathophysiological considerations. Stroke 2000;31:1766-9.  Back to cited text no. 3
Kulkarni GB, Ravi Y, Nagaraja D, Veerendrakumar M. Lower motor neuron facial palsy in cerebral venous sinus thrombosis. J Neurosci Rural Pract 2013;4:224-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
Mubbashir Shariff E, Alhameed M. Multiple cranial neuropathies in cerebral venous sinus thrombosis. Oxf Med Case Reports 2014;2014:21-3.  Back to cited text no. 5


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