• cerebral venous thrombosis
• marfan syndrome
• homocystinuria
• recessive inheritance

A 44-year-old man presented with a 6-day history of headache with nausea and progressive somnolence. He had been previously clinically diagnosed with Marfan’s syndrome, with a history of bilateral crystalline lens subluxation, elongated ascending aorta, tall stature, pectus excavatum and dorsolumbar scoliosis (figure 1). He also had evidence of mental retardation (IQ 50) and a psychiatric history.

On examination, he had mild neck stiffness but was afebrile. He showed right gaze deviation, left haemineglect and left homonymous haemianopia (National Institutes of Health Stroke Scale score=6). Non-contrast CT scan of head showed a temporal cortical vein thrombosis (figure 2). A CT venogram confirmed an extensive deep cerebral venous thrombosis that included the right internal jugular vein, right sigmoid and transverse sinuses, superior sagittal sinus and distal segment of rectus sinus (figure 3).