J Neurocrit Care.  2021 Dec;14(2):113-116. 10.18700/jnc.210025.

Supranuclear oculomotor palsy in cerebral venous sinus thrombosis: a case report

• Bismaya K
• Pattanayak S
• Dixit A
• Pathak A
• Chaurasia RN
• Singh VK

• KMID: 2523722
• DOI: http://doi.org/10.18700/jnc.210025

Abstract

Background
For certain ocular movement abnormalities, the exact neuroanatomical localization of the causative lesion is still not defined. Oculomotor apraxia, apraxia of eye opening and closing, and motor impersistence are rarely reported in acute stroke, particularly following venous stroke.
Case Report
A 34-year-old man presented with headache, vomiting, focal seizures with bilateral tonic-clonic movements, and altered sensorium. Magnetic resonance imaging revealed bilateral frontal and left parietal hemorrhagic infarcts, and contrast venography revealed superior sagittal sinus thrombosis. The patient received anticoagulant treatment with antiepileptics. On re-examination on day 3, the patient had a rare combination of apraxia of eyelid closure, motor impersistence, and oculomotor apraxia. By Day 10 of admission, all oculomotor abnormalities had subsided.
Conclusion
To the best of our knowledge, this is the first report of the combination of oculomotor apraxia and apraxia of eyelid closure with motor impersistence in a patient with cerebral venous sinus thrombosis.

Keyword

Cerebral venous sinus thrombosis; Eyelid apraxia; Oculomotor apraxia; Motor impersistence

Figure

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  Fig. 1. Magnetic resonance imaging of the patient showing bilateral frontal and left parietal hyperintensity on T2-weighted images (A), blooming at the same sites on susceptibility-weighted images (B) suggestive of hemorrhagic infarct and thrombosis of the anterior two-third of the superior sagittal sinus (C) on contrast venography.

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  Fig. 2. Magnetic resonance imaging of the patient showing normal parenchyma at the pontine level.

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