A Young Man with Sudden Headache and Vision Loss

• Main Authors: Ahmad Tirmizi, Jobli, Sharifah Aishah, Wan Mohamad Akbar, Teh, Cheng Lay, Cheong, Yaw Kiet, Chuah, Seow Lin
• Format: Article
• Language: English
• Published: MRE Press 2023
• Subjects: R Medicine (General)
• Online Access: http://ir.unimas.my/id/eprint/44025/4/Young.pdf; http://ir.unimas.my/id/eprint/44025/; https://www.jomh.org/articles/10.22514/jomh.2023.139
• Institution: Universiti Malaysia Sarawak

Introduction: The cerebrovascular adverse effects of methamphetamine include ischemic strokes, intracerebral haemorrhages and subarachnoid haemorrhages. There are few reports of methamphetamine-induced cerebral venous sinus thrombosis. Methods: We present a case report of a young man with sudden headache and visual loss. Results: A 24-year-old man presented with sudden severe headache, persistent vomiting and sudden vision loss. He had a one-week history of intermittent moderate headaches. There was no fever, rash, oral ulcers, joint pains, loss of appetite, loss of weight or trauma. He had been smoking cigarettes since 14 years old and was currently smoking 1 pack per day. He used inhaled “syabu” (crystal methamphetamine) twice a week and drinking 2 bottles of beers twice a week since 16 years old. Examination showed normal blood pressure, pulse rate, cardiovascular, respiratory and abdominal systems. Neurological examination showed reduced vision to finger counting of bilateral eyes and bilateral 6th nerve palsy. There were no other cranial nerve or peripheral nerve abnormalities. Fundoscopy showed bilateral papilloedema. Muscle tone, power, reflexes and sensory examinations were normal. Babinski was downgoing bilaterally. Blood investigations showed haemoglobin 15.2 g/dL, total white cell 15.3 × 103/μL, with low platelets 15,000/μL. Renal and liver profiles were normal. Peripheral blood film showed thrombocytopenia. Hepatitis B and Human Immunodeficiency Virus (HIV) tests were negative. Hepatitis C test was positive. A computed tomography cerebral venogram and subsequent magnetic resonance imaging brain showed extensive dural venous sinus thrombosis with venous infarction. Antinuclear antibody and antiphospholipid antibodies were negative. He was finally diagnosed with methamphetamine-induced dural venous sinus thrombosis with venous infarction, and drug-induced thrombocytopenia. He was ventilated for 48 hours for cerebral protection. His headache and visual loss resolved, but the bilateral 6th nerve palsy was persistent. The thrombocytopenia resolved. He was treated with anti-epileptic therapy, heparin and subsequently warfarin for 3 months. Conclusions: This case highlights an uncommon presentation of methamphetamine use.