EPOS

European Paediatric Ophthalmological Society

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Ocular tilt reaction and internuclear ophthalmoplegia associated with sinus venous thrombosis: an unusual case.

Gerth Christina¹, Buncic J Raymond^2
1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and The University of Toronto, Canada; Department of Ophthalmology, University of Rostock,, ²Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and The University of Toronto, Canada

We report about a 11 year old previously healthy girl, who presented with an acute history of vomiting, neck and back pain, diplopia and photophobia after a 4 day treatment for bilateral otitis media. Cerebral CT revealed a sinus thrombosis, which was treated with anticoagulation therapy. She developed a head tilt and unusual oculo-motor findings, progressive worsening of papilloedema with subsequent retinal nerve fiber layer and optic nerve atrophy. The case underlines the importance of early and regular ophthalmological assessment and surveillance in the diagnosis and management of patients with complicated venous sinus thrombosis and intracranial hypertension. In children too ill or young for reliable perimetry progressive optic disc and RNFL changes may be more useful in monitoring the effectiveness of treatment. INO and OTR may reflect marked degrees of intracranial hypertension and can serve as additional clinical parameters for the clinician to monitor.