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Aaron Fairbanks, Kevin Chodnicki, Elizabeth Lesser, David Hodge, Jacqueline Leavitt, James Garrity, John J Chen; Population-based incidence and visual outcomes of cerebral venous sinus thrombosis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2176.
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© ARVO (1962-2015); The Authors (2016-present)
The incidence of cerebral venous sinus thrombosis (CVST) has been previously reported in international studies ranging from 0.22-1.32/100,000 per year. However, data involving an American cohort and a population-based evaluation of visual outcomes have not been reported. The goal of this study was to evaluate the population-based incidence and visual outcomes of patients with CVST using the Rochester Epidemiology Project (REP), a well-established medical records linkage system designed to capture data on patient-physician encounters in a defined population.
The medical records of all adult residents of Olmsted County, MN, who were newly diagnosed with CVST from January 1, 1990, through December 31, 2015, were retrospectively reviewed using the REP. Patients were identified by diagnosis code and confirmed by evidence of CVST on neuroimaging. Data regarding etiology, presenting signs and symptoms, neuroimaging findings, and ophthalmic parameters were collected. Incidence rates were adjusted to the age and gender distribution of the 2010 US white population.
A total of 46 patients (age 39.9 +/- 15.6 years) with CVST were identified (65% women). The overall age- and sex-adjusted incidence of CVST was 1.47/100,000 per year (95% CI: 1.03-1.91). The incidence was 1.78/100,000 per year for women (95% CI: 1.13-2.43) and 1.16/100,000 per year for men (95% CI: 0.57-1.75). Of the women with CVST, 53.3% were taking hormonal therapy. Common presenting signs and symptoms were headaches (33; 71.7%), nausea (22; 47.8%), and focal neurologic deficits (20; 43.5%). Among patients with a documented disc appearance, 22.5% (9/40) had papilledema. Blurry vision (17.4%), diplopia (13%), and CN VI palsy (8.7%) were the other reported ophthalmic signs/symptoms. All patients had good visual function at follow-up except for two patients with constricted fields, one who was 20/40, and one patient with a homonymous quadrantanopia from a temporal lobe infarct due to CVST. One patient required surgical intervention (bilateral optic nerve sheath fenestration) and had complete recovery of vision.
To our knowledge, this is the first report of the incidence of CVST in a US population, which was similar to reported values from the international literature. Visual outcomes were good in the majority of patients. Surgical intervention was rare and only required in a single case of refractory high intracranial pressure.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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