Unilateral Papilledema in Cerebral Venous Sinus Thrombosis

Abstract

In the majority of patients with raised intracranial pressure, the papilledema is bilateral. Unilateral papilledema is rare in conditions causing intracranial hypertension, and it has been described in Foster–Kennedy syndrome and in some cases of idiopathic intracranial hypertension. It has never been reported in cerebral venous thrombosis. We report a young lady presenting with features of subacute onset of headache with seizures, on evaluation she had superior sagittal and bilateral lateral sinus thrombosis. The risk factors found on evaluation were Vitamin B12 deficiency and hyperhomocysteinemia. On optic fundus examination, she had swollen optic disc on the right side with normal fundus on the left side, confirmed with the orbital ultrasound B-scan and optic coherence tomography. Her magnetic resonance imaging showed features of raised intracranial pressure with thrombosis of the superior sagittal and bilateral lateral sinus thrombosis. She was treated with anticoagulation (heparin followed by oral anticoagulants), antiedema measures, and vitamin supplementation for hyperhomocysteinemia. She improved over time and was asymptomatic during follow-up. We discuss the possible mechanisms described in the literature for unilateral papilledema. This report highlights the need for carefully performing bilateral fundus examination so as not to miss the vision or life-threatening causes of a headache.

Clinical characteristics of cerebral venous sinus thrombosis patients with new-onset of headache

“…Also, 78.7% of our patients were females. It has been reported that headache is associated with papilledema in 25-75% of CVT patients 14 . The proportions of female patients in headache and non-headache groups were 55.67% and 29.42%, respectively.…”

Application of quality nursing to patients with cerebral thrombosis

“…The final questionnaire survey results were positively correlated with the nursing satisfaction degree of patients with cerebral thrombosis. The satisfaction degree was scored based on a 100 marking system [5]: strongly satisfying: ≥ 90 points; generally satisfying: ≥ 70 but <90; and strongly dissatisfying: <70.…”

Papilledema: A Comprehensive Assessment

“…[2] Recently, a case of unilateral papilledema associated with cerebral venous sinus thrombosis was described, evidencing a rare association in this challenging entity. [3] Optic nerve sheath anomalies (preventing the transmission of the raised cerebral spinal fluid [CSF]) and lamina cribrosa changes (increased collagen and decreased elasticity with aging) were hypothesize to explain unilateral papilledemas. [4] CSF opening pressure (which typically ranges from 10 to 25 cm of water) is the gold standard tool to diagnose increased ICP.…”

“…[4] The synchronic appearance of pituitary adenoma and meningioma has several theories; Furtado et al suggest an undetermined genetic association among simultaneous intracranial tumors, and describe certain abnormalities in chromosomes 14 and 22, which are shared between pituitary adenomas and meningiomas. [3,4] High levels of prolactin receptors or insulin-like growth factors 1 that stimulate mesodermic and ectodermic cell growth, that leads to tumor growth, may be present in functional adenomas. [4] Ubea et al have described that pituitary adenomas express fibroblast growth factor 1 and 2, along with multiple endocrine neoplasm, meningiomas and high circulating levels.…”

“…High-resolution imaging Sir, The coexistence of simultaneous pituitary adenoma and intracranial tumor is frequent and is widely identified in patients who have had radiotherapy as treatment for adenoma, as well as patients with neurocutaneous syndromes, such as Neurofibromatosis, and patients with breast cancer and meningioma apparently due to hormonal influence. [1][2][3] However, the presence of pituitary adenoma simultaneous with intracranial tumor is very rare, especially as an adjacent lesion. [1][2][3][4][5] A 57-year-old right-handed dominant man, with Type 2 diabetes, presented to the emergency unit after experiencing a generalized tonic-clonic seizure; he mentioned that he has had 3 previous episodes of seizures in past month, all of them involving disconnection with the environment, perioral cyanosis, urinary incontinence, and decreasing visual acuity.…”