Abstract
Introduction Cerebral venous sinus thrombosis (CVST) typically presents with headaches and intracranial complications of venous congestion including.
Methods Single case report.
Results A 67-year-old female presented with a 6 week history of taste change affecting the left side of the tongue and a rubbery sensation in her left cheek noted when chewing. MRI identified loss of flow voids in the left transverse sinus and no evidence of stroke or other intracranial pathology. CT venogram demonstrated an extensive filling defect in the left anterior transverse sinus extending to the left jugular bulb consistent with CVST. The patient commenced anticoagulation. Two months later her taste and buccal sensation were improving.
Discussion Taste sensation to the anterior two thirds of the tongue is supplied by the chorda tympani, a branch of the facial nerve that joins the lingual nerve. Sensation of the buccal mucosa is supplied by the long buccal nerve (branch of V3). The chorda tympani, lingual nerve and long buccal nerve traverse the infratemporal fossa in close anatomical association with the pterygoid venous plexus (2). Valveless emissary veins including the sphenoidal emissary vein and emissary vein of the foramen ovale, drain blood from the pterygoid plexus to the ipsilateral sphenoid sinus via the cavernous sinus (3). We postulate that obstruction of the usual venous outflow due to left transverse and sigmoid venous sinus thrombosis, resulted in dilatation of the left pterygoid venous plexus causing mechanical impingement of the chorda tympani and buccal nerve, with subsequent loss of taste and buccal sensation localised to the left. No alternative plausible explanation for the symptoms could be identified centrally based on clinical anatomical localisation or imaging findings.
Conclusion This case expands the spectrum of clinical presentation of CVST. It highlights the potential diversity of presentations related to the impact of venous congestion on central and peripheral neurological function.
