Sigmoid Sinus Thrombosis with Cerebellar Tuberculous Abscess: A Rare Case of Chronic Headache with Vision Loss

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare form of brain stroke which is often misdiagnosed. We present a case of CVST due to cerebellar tuberculous abscess. A 41-year female patient was admitted with chronic occipital headache, diminished vision, and fever. The initial brain CT scan was negative, but subsequent imaging (MRI with MRV) showed cerebellar abscess with sigmoid sinus thrombosis. Fundoscopy revealed bilateral optic atrophy. Marked improvement (subjective and objective) was noted after 4 weeks with anti-tuberculosis chemotherapy and anticoagulants. Vision loss was irreversible due to optic atrophy. The case is extremely rare due to the location, rare causative organism (tuberculosis) and complex clinical presentation (occipital headache with vision loss).

Cerebral tuberculoma are commonly accompanied by other imaging abnormalities

“…We should know if there was evidence for encephalitis, thrombosis, or abscess formation in any of the patients receiving gadolinium. Since cerebral tuberculosis can also be complicated by venous sinus thrombosis (VST) [ 2 ], we should know if magnetic resonance venography (MRV) was indicative of VST in any of the 73 patients.…”