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JAMA Ophthalmology Clinical Challenge
October 2016

Severe Headache and Blurred Vision

Author Affiliations
  • 1Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
  • 3Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2016;134(10):1191-1192. doi:10.1001/jamaophthalmol.2016.1295

A woman in her 30s presented 2 weeks after cesarean delivery complaining of bilateral blurred vision, photophobia, headache, and nausea. Her postoperative course had initially been complicated by the development of a transverse sinus thrombosis on postoperative day 4, for which she was treated with anticoagulation.

Over the next several days, she experienced marked worsening of her headaches, nausea, and blurred vision. She also noticed subjective fevers, weakness, and spasticity in her left upper and lower limbs, along with right ear pain and decreased hearing. Repeated magnetic resonance imaging and venography of the head and neck demonstrated worsening of the cerebral venous sinus thrombosis, now extending into the right sigmoid sinus and jugular vein. Additionally, opacification of the mastoid air cells on the right side was noted, consistent with mastoiditis. Physical examination revealed otitis media on the right side.

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