J Korean Ophthalmol Soc.  2019 Jun;60(6):606-611. 10.3341/jkos.2019.60.6.606.

Papilledema with Cerebral Venous Sinus Thrombosis

• Baek MS
• Kyung SE

• KMID: 2449716
• DOI: http://doi.org/10.3341/jkos.2019.60.6.606

Abstract

PURPOSE
We report two patients diagnosed with a sinus thrombosis with papillary edema.
CASE SUMMARY
Case 1 was a 27-year-old male who presented with complaints of headache and vomiting for 2 months and blurred vision in both eyes. The best-corrected visual acuity (BCVA) was 1.0 in the right eye and 1.0 in the left eye. A visual field (VF) examination revealed a binocular peripheral VF defect and optical coherence tomography (OCT) and a fundus examination indicated optic disc swelling in both eyes. Brain magnetic resonance imaging (MRI) showed no specific finding but magnetic resonance venography revealed filling defect signs in the transverse sinus and a cerebrospinal fluid examination indicated elevated intracranial pressure (ICP). Case 2 was a 54-year-old female who came to our hospital with suspicion of bilateral optic disc swelling. The BCVA was 0.9 in the right eye and 1.0 in the left eye. A VF examination revealed an inferior-temporal VF defect and blind spot enlargement in the right eye. OCT and a fundus examination showed optic disc swelling in both eyes. Brain MRI showed no specific finding but magnetic resonance venography revealed a decrease in blood flow in the transverse sinus, sigmoid sinus. A cerebrospinal fluid examination indicated elevated ICP.
CONCLUSIONS
In the case of optic disc swelling in both eyes, a secondary cause of ICP elevation and the possibility of optic disc swelling due to sinus thrombosis should be considered, and brain MRI and venography are needed to distinguish these possibilities.

Keyword

Optic neuropathy; Papilledema; Venous sinus thrombosis

MeSH Terms

Adult
Brain
Cerebrospinal Fluid
Colon, Sigmoid
Edema
Female
Headache
Humans
Intracranial Hypertension
Magnetic Resonance Imaging
Male
Middle Aged
Optic Disk
Optic Nerve Diseases
Papilledema*
Phlebography
Sinus Thrombosis, Intracranial*
Telescopes
Tomography, Optical Coherence
Visual Acuity
Visual Fields
Vomiting

Figure

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  Figure 1 Case 1. The fundus showed the diffuse optic disc swelling and hemorrhage in both eye at the first visit (A) OD, (B) OS. (C) The Optical coherence tomography showed the increased RNFL thickness in both eyes at the first visit. (D, E) The visual field showed peripheral constriction and enlarged blind spot in both eyes at the first visit. OD = oculus dexter; OS = oculus sinister; ONH = optic nerve head; RNFL = retinal nerve fiber layer; OU = oculus unitas; S = superior; N = nasal; T = temporal; I = inferior; POS = positive; NEG = negative; RX = prescription; DS = dioptres sphere; DC = dioptres cylinder; GHT = global hemifield test; VFI = visual field index; MD = mean deviation; PSD = pattern standard deviation.

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  Figure 2 Case 1. Low signal intensity contrast filling defect in superior sagittal sinus (posterior portion, red arrows), great vein of Galen, straight sinus, right transverse sinus (blue arrow), right sigmoid sinus (yellow arrow), and right IJV (green arrow) (A, B). SE = series; IJV = internal jugular vein; MR = magnetic resonance.

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  Figure 3 Case 2. The fundus showed the diffuse optic disc swelling and hemorrhage in both eye at the first visit (A) OD, (B) OS. (C) The Optical coherence tomography showed the increased RNFL thickness in both eyes at the first visit. (D, E) The visual field showed enlarged blind spot with inferior visual field defect in right eyes at the first visit. OD = oculus dexter; OS = oculus sinister; ONH = optic nerve head; RNFL = retinal nerve fiber layer; OU = oculus unitas; S = superior; N = nasal; T = temporal; I = inferior; POS = positive; NEG = negative; RX = prescription; DS = dioptres sphere; DC = dioptres cylinder; GHT = global hemifield test; VFI = visual field index; MD = mean deviation; PSD = pattern standard deviation.

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  Figure 4 Case 2. Smooth margined non visualization of flow signal right IJV (red arrows) and decreased flow signal in right transverse (blue arrow) and sigmoid sinus (yellow arrow) (A, B). SE = series; IJV = internal jugular vein; MR = magnetic resonance.

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