Case of the day

CSVT. Please give your opinions regarding further management.

55yrs male with headache. Chief Complaints Complaint of headache from past 15 days. Very dull ache from 17th may, 2021 which aggravated to severe headache on 23rd,24th may(used diclofenac). Visited the physician on 25th may and prescribed naproxen 500mg+ domperidone 10 mg combination. Relieved after 2 days. Sudden sharp pain on left temporoparietal region on and off daily from 28th april. On 4th may around 2:30 pm there are Weakness of rt fingers, Numbness around the right angle of mouth, Slurring of speech. All the above symptoms persisted for about just 5-6 minutes. History Diagnosed with narrow angle glaucoma both eyes in dec 2020, and on treatment since then. Not a known Diabetic or hypertensive. No drug allergies No food allergies. Vitals BP- around 120-130/80-90 in past 2 days. Temp- normal. Pulse- 80-90 beats per min. Investigations S.creatinine- 0.7 mg/dl.(N) RBS- 199 mg/dl (4th june, 10 pm) LFT's - Normal. HBA1C- 6.2% Mean blood glucose- 131 mg/dl. RT PCR - negative. Diagnosis Diagnosed as CEREBRAL SINO VENOUS THROMBOSIS. Management Kindly give your opinions. Thank you in advance.

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Most important in this patient is a neurological examination. Any patient with head ache needs an optic fundi examination. However NRV is suggestive of SSS with TS thrombosis. Needs complete investigations, blood work up including vasculitis ,Fasting homocystein. Start on Anticoagulant, single antiepileptic, if the optic fundi shows papilledema suggest iv. mannitol.Further management depend on the blood investigations.

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It would be great if you put films of MRI and MRV instead of reports Get D dimer done Start anticoagulant and monitor it Also keep watch in Raised ICP and other clinical condition, pt also required Anti seizure prophylaxis It would great if he treated directly under supervision of neurologist

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

In case of CVS,inj heparin 5600 unit iv stat then infusion @18 unit /hr

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sinus thrombosis..ref to neurologist

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Anti coagulants

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Plz get admission under neurologist

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I THINK YOU SHOULD REFER TO NEUROLOGIST??..

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