Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis

Liu, Katy C.; Bhatti, M. Tariq; Chen, John J.; Fairbanks, Aaron M.; Foroozan, Rod; McClelland, Collin M.; Lee, Michael S.; Satija, Celine E.; Francis, Courtney E.; Wildes, Michael; Subramanian, Prem S.; Williams, Zoë; El-Dairi, Mays

doi:10.1016/j.ajo.2019.12.022

Cited by 28 publications

(36 citation statements)

References 22 publications

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“…e-supplement Table 3 compares in detail demographics and clinical characteristics of patients in our series with important published literature. [ 1 4 11 12 13 15 16 ] We describe in brief important observations in our study as compared to prior literature.…”

Section: Discussionmentioning

confidence: 98%

Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis

Sachdeva

Nalawade

Kannam

et al. 2021

Indian J Ophthalmol

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Purpose: To report clinical profile, diagnostic challenges, and outcomes in cases of subacute/chronic cerebral sinus venous thrombosis (CSVT) presenting to neuro-ophthalmologists/neurologists. Methods: This was a multicentric, retrospective, observational study. Records of patients with neuroimaging proven subacute/chronic CSVT seen the from January 1, 2016 to March 31, 2020 were analyzed. Data collected included duration of symptoms, diagnosing physician, ophthalmological vs. focal/generalized neurological symptoms, optic disc examination, perimetry, and neuroimaging findings. Statistical analysis was performed using STATA software. Results: Forty-three patients with subacute (30)/chronic (13) CSVT were identified (32 males, 11 females). Median age was 37 (IQR 27–47) years. The presenting complaints were blurred vision 34 (79%), headaches in 25 (58%), vomiting 12 (28%), and diplopia 11 (26%). Eleven patients had associated sixth cranial nerve palsy. All but two patients had either disc edema/optic atrophy; four had unilateral disc edema at presentation. Ophthalmologists and neurologists diagnosed/suspected CSVT correctly in 13/29 (45%) and 11/14 (78.5%) patients, respectively. Most common initial alternate diagnosis was idiopathic intracranial hypertension in 12 (28%). Female gender, age ≤36, unilateral papilledema, not obtaining venogram at initial workup increased chances of initial alternate diagnosis. Median follow-up duration was 21 days. Average visual function remained stable in majority of patients at last follow-up. In total, 47.6% of patients had best-corrected visual acuity ≥20/30 at the final follow-up. Conclusion: In our series, subacute or chronic CSVT presented presented primarily with symptoms of intracranial hypertension. Unilateral papilledema, middle-aged patients, female gender, lack of focal/generalized neurological symptoms created diagnostic dilemma. Visual function remained stable in majority of patients.

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Section: Discussionmentioning

confidence: 98%

Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis

Sachdeva

Nalawade

Kannam

et al. 2021

Indian J Ophthalmol

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“…Even though most patients have good final visual acuity, a significant proportion (40%) suffer permanent visual field deficits. The risk of visual field loss increases with more severe papilledema grade (Frisen grade >3) and cases with progression of papilledema [7]. Although D-dimer is widely used to exclude possible deep-vein thrombosis or pulmonary embolism, it has shown a low sensitivity and specificity as a predictive factor for CVST [8].…”

Section: Discussionmentioning

confidence: 99%

“…Even though head trauma accounts for only 1-3% of cases of this rare venous thromboembolic disease [4,7], it is important for physicians to raise awareness of the diagnosis of CVST if a patient with definite history of head trauma shows persistent or worsening neurological symptoms despite negative results on serial non-contrast cranial CT scans.…”

Section: Discussionmentioning

confidence: 99%

Delayed Onset Bilateral Papilledema in a Young Boy’s Eyes after Trauma

Lin

Chien

2022

Medicina

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Cerebral venous sinus thrombosis (CVST) is a rare venous thromboembolic disease that affects young adults in their thirties, with a female predilection. Head trauma accounts for only 1–3% of cases among possible etiologies. Here, we present a particular case of trauma-related CVST with delayed-onset symptoms and signs in a young boy. A 12-year-old boy presented to the emergency department with non-specific visual symptoms 11 days after head trauma. Apart from mild-grade disc swelling in the right eye and dyschromatopsia in both eyes, no significant findings were revealed during physical examinations and a non-contrast cranial computed tomography (CT) scan. Unfortunately, the patient suffered multiple seizure attacks the following day. Trauma-related CVST, complicated by delayed-onset increased intracranial pressure, and bilateral papilledema were finally diagnosed. Physicians need increased awareness of a possible CVST diagnosis if a patient with a history of head trauma shows persistent or worsening neurological symptoms despite negative results on serial non-contrast cranial CT scans.

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“…Papilledema 33,34 is the only objective clinical sign of intracranial hypertension. 35,36 Because the degree of papilledema at presentation is a reliable indicator of subsequent visual outcomes from secondary optic atrophy, [3][4][5][6][7][8][9] the severity of papilledema influences the management and the frequency of visual monitoring during follow-up of patients with elevated ICP. 37,38 Our simple binary classification of papilledema severity aimed at identification of patients with lower risk (mild to moderate papilledema) or higher risk (severe papilledema) of visual loss.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of a Deep Learning System for Classification of Papilledema Severity on Ocular Fundus Photographs

Vasseneix¹,

Najjar²,

Xu³

et al. 2021

Neurology

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Objective:To evaluate the performance of a deep learning system (DLS) in classifying the severity of papilledema associated with increased intracranial pressure, on standard retinal fundus photographs.Methods:A DLS was trained to automatically classify papilledema severity in 965 patients (2103 mydriatic fundus photographs), representing a multiethnic cohort of patients with confirmed elevated intracranial pressure. Training was performed on 1052 photographs with mild/moderate papilledema (MP) and 1051 photographs with severe papilledema (SP) classified by a panel of experts. The performance of the DLS and that of three independent neuro-ophthalmologists were tested in 111 patients (214 photographs, 92 with MP and 122 with SP), by calculating the area under the receiver operating characteristics curve (AUC), accuracy, sensitivity and specificity. Kappa agreement scores between the DLS and each of the three graders and among the three graders were calculated.Results:The DLS successfully discriminated between photographs of MP and SP, with an AUC of 0.93 (95%CI: 0.89-0.96) and an accuracy, sensitivity and specificity of 87.9%, 91.8% and 86.2%, respectively. This performance was comparable with that of the three neuro-ophthalmologists (84.1%, 91.8% and 73.9%, P=0.19, P=1, P=0.09, respectively). Misclassification by the DLS was mainly observed for moderate papilledema (Frisén grade 3). Agreement scores between the DLS and the neuro-ophthalmologists’ evaluation was 0.62 (CI 95% 0.57-0.68), whereas the inter-grader agreement among the three neuro-ophthalmologists was 0.54 (CI 95% 0.47-0.62).Conclusions:Our DLS accurately classified the severity of papilledema on an independent set of mydriatic fundus photographs, achieving a comparable performance with that of independent neuro-ophthalmologists.Classification of Evidence:This study provides Class II evidence that a deep learning system using mydriatic retinal fundus photographs accurately classified the severity of papilledema associated in patients with a diagnosis of increased intracranial pressure.

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Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis

Cited by 28 publications

References 22 publications

Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis

Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis

Delayed Onset Bilateral Papilledema in a Young Boy’s Eyes after Trauma

Accuracy of a Deep Learning System for Classification of Papilledema Severity on Ocular Fundus Photographs

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