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Dural sinus thrombosis in Behçet's disease--a case report
1Department of Ophthalmology, Osaka University School of Medicine, Japan.
Insights
Diagnosing sinus thrombosis causing pseudotumor cerebri is challenging. Magnetic resonance angiography (MRA) successfully identified sagittal sinus thrombosis in a Behçet's disease patient, aiding treatment.
Area of Science:
- Neurology
- Vascular Imaging
- Rheumatology
Background:
- Sinus thrombosis can lead to pseudotumor cerebri, often presenting diagnostic challenges with conventional CT and MRI.
- Behçet's disease is a multisystem inflammatory disorder associated with thrombotic events.
Observation:
- A 45-year-old male with a history of Behçet's disease presented with severe headache and bilateral papilledema.
- Standard CT and MRI scans revealed no intracranial lesions, hindering diagnosis.
- Magnetic resonance angiography (MRA) identified an obstruction in the sagittal sinus.
Findings:
- MRA is crucial for diagnosing sinus thrombosis, especially in complex cases like Behçet's disease.
- Anticoagulant and steroid therapy provided temporary relief of symptoms and improved visual fields.
- Despite treatment, persistent papilledema and subsequent optic atrophy led to vision loss.
Implications:
- This case highlights the utility of MRA in diagnosing sinus thrombosis when conventional imaging is inconclusive.
- Early diagnosis and intervention for sinus thrombosis in Behçet's disease are critical for visual preservation.
- Further research is needed to optimize management strategies for sinus thrombosis in inflammatory conditions.
Abstract:
Sinus thrombosis, which causes pseudotumor cerebri, is difficult to diagnose with conventional imaging apparatus, CT and MRI. We report a case of sinus thrombosis due to Behçet's disease diagnosed by magnetic resonance angiography (MRA). A forty-five-year old man with severe headache and ocular pain was examined. Since he had a history of oral ulcers, genital ulcers, and erythema nodosum venous thrombosis, he had been diagnosed as having Behçet's disease previously. He showed marked papilledema bilaterally but no obvious intracranial lesion was observed by CT and MRI. On MRA, an obstruction was apparent at the sagittal sinus. Anticoagulant and steroid therapy were effective to relieve the headache, and to improve the constricted visual field temporarily. By MRA, blood flow was confirmed in the sagittal sinus. However, mild papilledema persisted and finally vision was lost because of optic atrophy.