Two patients, females aged 24 and 25 years, with raised intracranial pressure and dural venous sinus thrombosis, who presented with periorbital bruising, are reported from Moorfields Eye Hospital, and the National Hospital for Neurology and Neurosurgery, London, UK. Patient 1 had a history of migraine, and spontaneous periorbital bruising was preceded by a 1-week history of severe generalized headache that awakened her at night and was associated with vomiting, photophobia, and neck stiffness. She had bilateral acute papilledema, and brain CT findings were consistent with a thrombosis of the superior sagittal sinus and a venous infarct in the right frontal lobe, confirmed by MRI and MR venography. Periorbital bruising resolved after treatment with heparin and warfarin. Patient 2 was 25 weeks pregnant when she presented with periorbital bruising, headache, neck stiffness, vomiting, and photophobia. She had a sixth nerve palsy and papilledema, and the MRI and MRV were normal. CSF had an opening pressure of 46 cm, and normal constituents. Headache improved after lumbar puncture, and bruising resolved in the weeks following treatment with acetazolamide. Dural sinus thrombosis was considered likely. [1]

COMMENT. Periorbital bruising is considered a unique complication of dural sinus thrombosis with raised intarcranial pressure. In patient 1, the bruising had initially been mistaken for a case of assault.

Long-term prognosis of cerebral venous thrombosis (CVST) in childhood was studied in 17 children, aged 1 month to 16 years, at University Medical Center Utrecht, the Netherlands [2]. Mean follow-up was 2 years 8 months. The cause of CVST was mastoiditis in 10, complicated by meningo-encephalitis in 2; 2 had acute lymphatic leukemia, 1 a non-Hodgkin’s lymphoma, 1 had sickle cell disease, and 1 a malignant histiocytosis and bone marrow transplantation. Twelve presented with raised intracranial pressure, 8 had seizures, and 3 had a focal paresis. The sigmoid sinus was involved in 12, and superior sagittal in 4. Five died of heart tamponade, meningo-encephalitis, or infection complicating cancer, 3 at an early stage and 2 during follow-up. Mean age of 12 survivors at follow-up was 8 years 7 months (range 2 years 8 months to 20 years). No neurologic deficits occurred in 11, and a mild disability in 1. Chronic daily headache occurred in 2, and only 1 of 4 survivors with seizures still required AEDs after 1 year follow-up. All of 10 tested had average or above average IQ, 2 had mild learning or attention and behavior problems, and 3 had decreased physical wellbeing. Children who survive CVST have a fair prognosis, and most have normal cognitive and physical development. Mild cognitive deficits and reduction in quality of life are infrequent sequelae.