Prosopometamorphopsia as an Unusual Presentation of Cerebral Venous Sinus Thrombosis in a 33-Year Old Filipino: A Case Report

Introduction: Prosopometamorphopsia is a rare disorder of facial distortion that can be caused by cerebral infarcts, seizures, migraines, or trauma. In the most recent review of literature, there are no published reports for prosopometamorphopsia in cerebral venous sinus thrombosis. Objective: We discuss the case of a 37-year-old female who presented with acute onset facial distortions. Laboratories: Cranial magnetic resonance imaging with contrast revealed venous sinus thrombosis involving the mid-to-caudal superior sagittal sinus, some of the bilateral parietal cortical veins, torcular herophili, right transverse sinus, right sigmoid sinus, and right upper internal jugular vein without cerebral edema and hemorrhage. Optic disc photography revealed papilledema consistent with increased intracranial pressure. Blood work results were unremarkable. Results: The patient was diagnosed in a timely manner and started on low molecular weight heparin (enoxaparin 1mg/kg every 12 hours) upon admission. She was discharged after three days of hospitalization, clinically improved and asymptomatic, on dabigatran 150 mg twice daily. Conclusion: Prosopometamorphopsia is a rare phenomenon that should be recognized as an initial and unusual presentation of cerebral venous sinus thrombosis (CVST). Timely neuroimaging and anticoagulation can lead to rapid resolution of symptoms and favorable outcomes.