Rare Presentation of Lower Motor Neuron Facial Palsy in Cerebral Venous Thrombosis – A Case Report

Abstract

Clinical features of cerebral venous sinus thrombosis commonly include headache, early and late seizures, and focal deficits. Cranial nerve (CN) involvement primarily includes the ocular motor nerves. Very few cases have been reported with isolated facial nerve involvement. Our case highlights a rare atypical clinical presentation of cerebral venous thrombosis (CVT). Facial nerve palsy in cerebral and cortical vein thrombosis is rare with an unclear pathophysiology and is rarely reported. We report a case of a 44-year-old male, a chronic alcoholic admitted with complaints of severe headache and raised intracranial pressure (ICP) features. He developed left-sided facial nerve palsy with impaired taste perception on the left side. Magnetic resonance imaging (MRI) of the brain and venography showed evidence of a late subacute stage of occlusion in the superior sagittal sinus, straight sinus, right transverse, and right internal jugular vein (IJV) with features of intracranial hypertension. Facial palsy in our patient is considered to be due to transient neuropraxia in the intracranial segment of the nerve. This case highlights facial palsy as a rare clinical presentation of cerebral venous thrombosis.

Keywords

• anticoagulation
• case report
• cerebral venous thrombosis
• cerebral venous sinus thrombosis
• facial palsy
• papilledema