Purchase this article with an account.
Katy Liu, Tariq Bhatti, Mays El-Dairi; Presentation and Progression of Papilledema in Venous Sinus Thrombosis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4556.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Venous sinus thrombosis (VST) is a rare and potentially vision- and life-threatening condition. Papilledema is present in 32-48% of adult patients with VST; however, the presentation and progression of papilledema have not been well described. We performed a retrospective chart review of patients with VST who underwent serial eye examinations to develop guidelines for the monitoring of papilledema in such cases.
The study included any patient presenting with the diagnosis of VST to the Neuro-ophthalmology clinic at the Duke Eye Center from 2008 to 2015. We identified 10 patients (7 adult, 3 pediatric) with VST confirmed by neuroimaging. Outcome measures included time from diagnosis to development of papilledema, progression of papilledema, time to resolution of papilledema and final visual outcome.
The time from diagnosis of VST to papilledema ranged from the same day to three months. Bilateral papilledema grade ≥3 was present in 9 of 10 patients. One patient had grade 0 papilledema. In two cases, papilledema was not present on the initial examination. Two cases showed worsening of papilledema grade prior to intervention. Worsening of papilledema was detected at 1-week follow-up in both cases, and both patients were examined weekly until response to treatment. Three patients were initially diagnosed with papilledema in the setting of idiopathic intracranial hypertension but were subsequently found to have VST. Four patients required surgical intervention: 2 patients had optic nerve sheath fenestration (ONSF), 1 patient had a ventriculoperitoneal shunt placed, and 1 patient underwent ONSF followed by lumboperitoneal shunt. Time to resolution of papilledema ranged from 3 weeks to 1 year. Final visual acuity ranged from 20/20 to light perception (LP) with 5 of 10 patients with visual impairment.
Our study indicates the importance of serial ophthalmic evaluation in all patients with VST. Specifically, we recommend an ophthalmic examination at the time of diagnosis with follow-up weekly for 1 to 2 weeks. Follow-up fundoscopy is critical given that a subset of cases showed delayed onset and/or worsening of papilledema.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only