Neurology: Case of the Month

Test Yourself — Patient 45

Intracranial Hypertension due to Sigmoid Sinus Thrombosis

  1. Which of the following is NOT a presentation of cerebral sinovenous thrombosis (CVT)?
    • [ A ] Retro-ocular pain and diplopia, followed by confusion and lethargy.
    • [ B ] Acute onset headache with mild lateral diplopia, but no papilledema.
    • [ C ] Ascending, bilateral paralysis beginning in the legs.
    • [ D ] Focal motor seizure affecting the left leg, with subsequent generalization.
    • [ E ] None of the above.
  2. In young women, cerebral venous thrombosis associated with pregnancy occurs most frequently during...
    • [ A ] First trimester
    • [ B ] Second trimester
    • [ C ] Third trimester
    • [ D ] Postpartum period
  3. Which of the following statements is TRUE:
    • [ A ] Visual loss related to papilledema from intracranial hypertension is often acute.
    • [ B ] Visual acuity is a sensitive marker in the evaluation of visual loss related to papilledema.
    • [ C ] There is a higher frequency of vision loss in patients with IIH (idiopathic intracranial hypertension) than in patients with cerebral sinovenous thrombosis.
    • [ D ] Cerebral venous thrombosis is rarely associated with venous thrombosis in other organ systems.
  4. Which of the following statements is FALSE:
    • [ A ] Thrombocytopenia can cause cerebral sinovenous thrombosis (CVT).
    • [ B ] Monoplegia of the contralateral leg may follow occlusion of the superior cerebral vein.
    • [ C ] CT head (with and without contrast) is normal in 60-70 percent of patients with CVT.
    • [ D ] Crowe's sign is distention of the scalp and face veins when the jugular vein contralateral to the occluded lateral sinus is compressed.
    • [ E ] Crohn's disease is associated with increased cerebral arterial and venous events.
  5. A diagnosis of septic cerebral venous thrombosis (CVT) would be supported by WHICH of the following findings:
    • [ A ] Fever and radiographic evidence of mastoiditis
    • [ B ] Absence of leukocytosis
    • [ C ] CSF evidence of partially treated bacterial meningitis
    • [ D ] A and C
    • [ E ] A, B, and C

 

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