Ocular Manifestations of Cerebral Sinus Venous Thrombosis: Horizontal Bidirectional Nystagmus Observed

Cerebral sinus venous thrombosis (CSVT) is a rare form of stroke, accounting for approximately 0.5%–1% of all stroke cases, with an annual incidence ranging from 0.22 to 1.32 per 100,000 population. It commonly affects younger individuals and children, with a higher prevalence in women compared to men, although this difference diminishes after the age of 60. CSVT presents with a wide spectrum of clinical manifestations, the most common being headache, often resembling migraine due to increased intracranial pressure, along with focal neurological deficits that may mimic other stroke syndromes. The insidious onset and variability of symptoms frequently result in delayed or missed diagnoses. Accurate and timely diagnosis relies heavily on neuroimaging techniques, including Computed Tomography Venography (CTV) and Magnetic Resonance Venography (MRV), as laboratory investigations alone are insufficient to confirm the condition. Thrombi most commonly occur in the transverse, superior sagittal, and sigmoid sinuses, although involvement of deeper venous systems may also occur. Early and appropriate management significantly influences patient outcomes, with anticoagulation therapy—using Unfractionated Heparin (UFH) or Low Molecular Weight Heparin (LMWH)—being the mainstay of treatment during the acute phase. Adjunctive therapies and prevention of complications are also essential components of care. This report highlights the clinical features, diagnostic challenges, and management strategies of CSVT, emphasizing the importance of early recognition to improve prognosis and reduce morbidity.