Treatment and Rehabilitation of Patient with Dural Venous Sinus Thrombosis: A Case Report

Case Diagnosis: 50 year old female presented to the emergency department with left homonymous hemianopsia who was found to have a dural venous sinus thrombosis (DVST) which was treated IR mechanical thrombectomy and was then admitted to a rehabilitation hospital where she was able to reach over 70% of her original baseline function.

Case Description or Program Description: Physical exam showed deficits in the left visual field of both eyes. An MRI and MR venogram was conducted to confirm the diagnosis of a DVST. Heparin was initiated and thrombectomy was performed 2 days later, but she continued to have vision difficulties so was transferred to a rehabilitation hospital.

Setting: In rehab, the patient was required to participate in ongoing therapeutic intervention with multiple therapy disciplines: physical, speech, and occupational. She completed a rigorous course of 3 hours a day for 5 days a week. Patient was expected to make measurable functional gains with strength & endurance, transfers, ambulation, visual scanning, and ADLs.

Assessment/Results: The patient successfully reached over 70% of her baseline function and vision.

Discussion (relevance): DVST is a thrombotic obstruction of the cerebral venous system that can lead to ischemic lesions or hemorrhages in the brain. Visual impairment is a common manifestation of DVST, and homonymous hemianopsia is a peripheral field defect that causes same-sided visual loss in both eyes. Treatment includes anticoagulation with heparin, but surgical correction through thrombectomy is conducted when indicated. Physical therapy includes improving motor function such as strength, coordination, and balance. Visual therapy includes visual scanning. Occupational therapy consists of functional mobility and basics of standard living.

Conclusions: DVST is a rare condition characterized by a thrombotic obstruction of the cerebral venous system. Treatment with anticoagulation and evaluation for thrombectomy is vital to the prognosis of the patient. Rehabilitation will include physical, speech, visual, and occupational therapy with the goal of reaching original baseline functionality.