Successful anticoagulation for bilateral CRVO accompanied by cortical vein thrombosis- a case report

Abstract

40 year old female a presented with symptoms of sudden painless loss of vision in both eyes since 3 days LE more than RE. On examination, Right eye vision 6 18 NIP.Anterior segment examination was normal with abduction movement restriction. Fundus shows pale disc with blurred margins,arteriolar narrowing, venous tortuosity ,flame shaped hemorrhage in the supero temporal quadrant with absent foveolar reflex.Left eye vision was perception of light .Anterior segment examination shows RAPD and abduction movement restriction .Fundus shows pale disc with blurred                        margins,arteriolar narrowing, venous tortuosity with multiple flame shaped hemorrhages in all four quadrants and hard exudates in the macula with absent foveolar reflex. Blood investigations were done .Patient underwent imaging                  techniques,which shows cortical venous sinus thrombosis with bilateral acute frontal lobe infarcts. Patient was treated with anticoagulants and antiedema measures.On follow up after 2 months,vision in LE showed improvement,pupil was 4mm with RAPD and defective colour vision. Fundus of the right eye showed pale disc with blurred margins,arteriolar narrowing, venous tortuosity with absent foveolar reflex.   Fundus of the left eye showed pale disc with blurred                 margins,arteriolar narrowing, veins tortuosity with resolving flame shaped hemorrhags and hard exudates in the macula with absent foveolar reflex.On concluding , patient was started on treatment based on clinical, CT and MRI findings and showed rapid recovery of vision in LE, thus stressing the importance of starting rapid anti coagulation therapy in cases presenting with CRVO and associated cortical vein                   thrombosis