Papilledema with Cerebral Venous Sinus Thrombosis

Min Su Baek; Sung Eun Kyung

doi:10.3341/jkos.2019.60.6.606

Journal List > J Korean Ophthalmol Soc > v.60(6) > 1127194

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Baek and Kyung: Papilledema with Cerebral Venous Sinus Thrombosis

Case Report

Journal of the Korean Ophthalmological Society 2019; 60(6): 606-611.

Published online: 17 June 2019

DOI: https://doi.org/10.3341/jkos.2019.60.6.606

Papilledema with Cerebral Venous Sinus Thrombosis

Min Su Baek, MD, Sung Eun Kyung, MD, PhD

Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea.

Address reprint requests to Sung Eun Kyung, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: 82-41-550-6497, Fax: 82-41-561-0137, kseeye@hanmail.net

Received 8 August 2018 Revised 29 October 2018 Accepted 17 May 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Optic neuropathy, Papilledema, Venous sinus thrombosis

Figures and Tables

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.

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.

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.

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.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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