Abstract

Case Report

The Rarest Case of Acute Bulbar Palsy due to Internal Jugular Vein Thrombosis Secondary to Protein S Deficiency: Vernet Syndrome

Richmond Ronald Gomes*

Published: 10 June, 2025 | Volume 9 - Issue 1 | Pages: 052-055

Dural Venous Sinus Thrombosis (DVST) is a rare although serious clinical entity that causes approximately 0.5% of all stroke cases. Head trauma with skull base fracture, aneurysm, CNS infection, thrombophilia, and vasculitis may be identified as a possible cause of DVST. Vernet’s Syndrome is characterized by a constellation of unilateral cranial nerve palsies involving the 9th, 10th, and 11th cranial nerves due to compression or narrowing of the jugular foramen. We herein present a case of 33 years old Bangladeshi worker from Malaysia who had history of severe Traumatic Brain Injury (TBI) following road traffic accident with multiple skull bone fracture and extradural hematoma 3 months back, presented with acute dysphagia, dysphonia, fever and cough for 6 days. Neurologic examination revealed deviation of uvula to the left side and features of consolidation over right upper chest. Magnetic Resonance Venography (MRV) revealed thrombosis involving right transverse sinus, sigmoid sinus extending up to right internal jugular vein. The diagnosis of vernet syndrome with aspiration pneumonia was made. Later thrombophilia screen showed protein S deficiency. He was treated with broad spectrum antibiotics and started anticoagulation with dabigatran. After 6 months of anticoagulation he recovered fully with no residual neurological deficit.

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Keywords:

Dural venous sinus thrombosis; Vernet syndrome; Protein S; Dabigatran

References

  1. Filippidis A, Kapsalaki E, Patramani G, Fountas KN. Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment. Neurosurg Focus. 2009;27:E3. Available from: https://doi.org/10.3171/2009.8.focus09167
  2. Robbins KT, Fenton RS. Jugular foramen syndrome. J Otolaryngol. 1980;9:505–516. Available from: https://pubmed.ncbi.nlm.nih.gov/7206037/
  3. Ha SW, Kim JK, Kang SJ, Kim MJ, Yoo BG, Kim KS, et al. A case of Vernet's syndrome caused by non-specific focal inflammation of the neck. J Korean Soc Clin Neurophysiol. 2007;9:81–84. Available from: https://www.e-acn.org/journal/view.php?number=300
  4. Bakar B, Tekkök IH. Venous sinus thrombosis after closed head injury: case report. Ulus Travma Acil Cerrahi Derg. 2010;16:98–102. Available from: https://pubmed.ncbi.nlm.nih.gov/20209407/
  5. Caplan JM, Khalpey Z, Gates J. Closed traumatic head injury: dural sinus and internal jugular vein thrombosis. Emerg Med J. 2008;25:777–778. Available from: https://doi.org/10.1136/emj.2008.061952
  6. Hayashi T, Murayama S, Sakurai M, Kanazawa I. Jugular foramen syndrome caused by varicella zoster virus infection in a patient with ipsilateral hypoplasia of the jugular foramen. J Neurol Sci. 2000;172:70–72. Available from: https://doi.org/10.1016/s0022-510x(99)00263-4
  7. Kawabe K, Sekine T, Murata K, Sato R, Aoyagi J, Kawase Y, et al. A case of Vernet syndrome with varicella zoster virus infection. J Neurol Sci. 2008;270:209–210. https://doi.org/10.1016/j.jns.2008.03.005
  8. Einhäupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, Masuhr F; European Federation of Neurological Societies. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010;17:1229–1235. Available from: https://doi.org/10.1111/j.1468-1331.2010.03011.x
  9.       Beer-Furlan A, de Almeida CC, Noleto G, Paiva W, Ferreira AA, Teixeira MJ. Dural sinus and internal jugular vein thrombosis complicating a blunt head injury in a pediatric patient. Childs Nerv Syst. 2013;29:1231–1234. Available from: https://doi.org/10.1007/s00381-013-2184-7

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