Young Woman Treated for Rare Brain Clot and Eye Nerve Swelling with LP Shunt Surgery

Chennai: A 23-year-old woman from Adyar was recently treated at Iswarya Hospital, OMR, Chennai, for cortical venous thrombosis (CVT) and bilateral papilledema.

The underlying cause was identified as hyperhomocysteinemia, a rare inherited condition that leads to elevated homocysteine levels in the blood and increases the risk of thrombosis.

The patient had presented with a progressive headache and persistent vomiting. An MRI scan showed blood clots in the cortical veins and dural venous sinuses, which caused raised intracranial pressure.

A fundus examination confirmed bilateral papilledema, indicating swelling of the optic discs due to the increased pressure.

Further evaluation revealed hyperhomocysteinemia as the root cause. To manage the elevated intracranial pressure and reduce the risk of neurological damage, the hospital’s neurology team performed a lumboperitoneal (LP) shunt procedure.

A programmable valve, typically used in ventriculoperitoneal shunts, was used in this case to help regulate cerebrospinal fluid (CSF) drainage.

The surgery lasted over three hours and was followed by improvement in imaging findings and reduction of papilledema. The patient was discharged in stable condition.

"This case not only highlights the importance of early neurological evaluation in young adults with unusual symptoms but also brings attention to rare inherited conditions like hyperhomocysteinemia, which, if left undiagnosed, can lead to devastating outcomes," said Dr Ragavendar, Consultant Neurologist, Iswarya Hospital.

"Very few centres in India currently adopt this technique for LP shunts and the programmable valve helps reduce the risk of over-drainage, a common complication in these patients," he added.

"Early detection of papilledema can be lifesaving for all young patients with persistent or unexplained headache, it is crucial to perform a fundus examination to know the exact reason for the headache," said Dr Balasubramaniam, Senior Consultant Neurologist, Iswarya Hospital.

"This successful case emphasizes the need for heightened clinical awareness of rare causes of stroke in young adults, such as hyperhomocysteinemia, and showcases Iswarya Hospital’s leadership in specialized neuro care," he added.

"This case reflects our hospital’s dedication to advanced and compassionate neurological care. Early diagnosis and skilled intervention enabled a full recovery for this young woman suffering from a rare and potentially fatal disorder," said Dr Arun Muthuvel, Managing Director of Iswarya Hospital.

The patient continues to recover under follow-up care.