BILATERAL CAVERNOUS SINUS THROMBOSIS IN A PREGNANT WOMAN: CASE REPORT

Abstract

This study aimed to describe the clinical case of a pregnant woman with bilateral cavernous sinus thrombosis, aiming to further understand its clinical presentation, diagnostic methods, progression, treatment, and maternal and fetal outcomes. In preparation for hemostasis after delivery, the pregnant woman begins to experience a hypercoagulable physiological state that predisposes her and her postpartum mother to venous thrombosis from the first trimester. In cavernous sinus thrombosis (CST), ocular signs predominate, including orbital pain, periorbital edema, ophthalmoplegia, chemosis, proptosis, and paralysis. CST is rare and can be associated with significant patient mortality. It is usually septic, with aseptic causes being less common. Risk factors include pregnancy, the postpartum period, women using oral contraceptives, hormone replacement therapy, and genetic thrombophilic disorders. Therefore, given the difficulties associated with diagnosing this condition and the high risk to both mother and fetus, presenting this case report of TSC concomitant with pregnancy is relevant. This is an observational, descriptive study in the form of a case report. Data collection was conducted through structured dialogue with the patient and in-depth analysis of her medical records, using primary and secondary sources to evaluate different perspectives and validate the information. The patient is a 23-year-old pregnant woman with intense and persistent headaches that progressed to reduced visual acuity, gaze deviation, diplopia, facial paresis, and bilateral papilledema. After discussing the case with the ophthalmology, obstetrics, and neurology teams, an angiographic resonance imaging of the intracranial arterial and venous vessels was requested. This revealed filling defects on post-contrast acquisitions in both cavernous sinuses, associated with increased signal intensity in the retrobulbar portions of the optic nerves, confirming the diagnosis of bilateral cavernous sinus thrombosis. This case presented the unusual finding of aseptic CST, with no associated risk factors other than pregnancy. Medical therapy included low-molecular-weight heparin combined with multidisciplinary care, enabling symptomatic improvement and monitoring of the condition until a full-term delivery with a favorable outcome for both mother and newborn.