Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis.

Journal Article (Journal Article;Multicenter Study)

PURPOSE: To determine the natural history and visual outcomes of papilledema in cerebral venous sinus thrombosis (CVST). DESIGN: Retrospective observational case series. METHODS: This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented papilledema from 2008-2016. Outcome measures included time from diagnosis to papilledema documentation, papilledema progression, time to papilledema resolution, treatment interventions and final visual outcomes. RESULTS: Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to papilledema documentation was 29 days with a mean (SD) initial Frisén grade of 2.7 (1.3). In 21.5% of cases, papilledema progressed over an average of 55.6 (56.6) days. Time to papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Frisén grade ≥3 (odds ratio [OR] 10.21, P < .0053) and cases with worsening papilledema (3.5, P < .043) were associated with permanent visual field deficits. CONCLUSIONS: Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes.

Full Text

Duke Authors

Cited Authors

  • Liu, KC; Bhatti, MT; Chen, JJ; Fairbanks, AM; Foroozan, R; McClelland, CM; Lee, MS; Satija, CE; Francis, CE; Wildes, MT; Subramanian, PS; Williams, ZR; El-Dairi, MA

Published Date

  • May 2020

Published In

Volume / Issue

  • 213 /

Start / End Page

  • 1 - 8

PubMed ID

  • 31926886

Electronic International Standard Serial Number (EISSN)

  • 1879-1891

Digital Object Identifier (DOI)

  • 10.1016/j.ajo.2019.12.022

Language

  • eng

Conference Location

  • United States