Superior Ophthalmic Vein Thrombosis Presenting as Isolated Headache: A Case Report

Superior ophthalmic vein thrombosis (SOVT) is a rare condition that can present with varied symptoms, including headache and orbital pain. Its diagnosis requires advanced imaging techniques, including CT angiography and MRI. This case report describes a patient presenting with headache and orbital pain attributed to superior ophthalmic vein dilation and thrombosis.

An 81-year-old female patient presented with headache, orbital pain, periorbital edema, and mild palpebral ptosis. Initial investigations included a brain CT scan and CT angiography, which revealed tortuous and dilated superior ophthalmic veins with massive thrombosis of the left superior ophthalmic vein. Brain MRI and MR angiography were also performed. Other examinations included ophthalmological evaluation, fluorescein angiography, and blood tests. The patient's symptoms, including headache and orbital pain, were attributed to the confirmed dilation and massive thrombosis of the left superior ophthalmic vein. CT angiography initially suggested a carotid-cavernous fistula, which was subsequently excluded by brain MRI and MR angiography. Fluorescein angiography revealed severe myopic chorioretinopathy with peripapillary atrophy and disc hyperfluorescence consistent with venous congestion in the left eye. Thrombophilia screening identified elevated anticardiolipin IgM antibodies, raising suspicion for antiphospholipid syndrome (APS). Anticoagulant therapy was initiated with enoxaparin and subsequently transitioned to warfarin, in accordance with current guidelines that favor vitamin K antagonists over direct oral anticoagulants for APS-associated thrombosis.

This case highlights the importance of considering SOVT in the differential diagnosis of headache accompanied by orbital symptoms.