Chronic deep venous thrombosis of the petrosal sinus causing multiple cranial nerve palsy

A 72 year old gentleman was referred for an MRI study of the brain for evaluation of long standing trigeminal neuralgia and right sided 6th nerve paralysis of more than 2 year duration. He had a history of deep venous thrombosis of the lower limbs for which he had been on warfarin which was later discontinued. There were no findings suggestive of raised intracranial pressure. MRI revealed thrombosis of the right sigmoid sinus with extension of thrombus into the petrosal sinus in relation to the 6th and 5th cranial nerves (Figures 1 a and 1b).