TY - JOUR
T1 - Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis
AU - Liu, Katy C.
AU - Bhatti, M. Tariq
AU - Chen, John J.
AU - Fairbanks, Aaron M.
AU - Foroozan, Rod
AU - McClelland, Collin M.
AU - Lee, Michael S.
AU - Satija, Celine E.
AU - Francis, Courtney E.
AU - Wildes, Michael T.
AU - Subramanian, Prem S.
AU - Williams, Zoë R.
AU - El-Dairi, Mays A.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ajo.2019.12.022
DO - 10.1016/j.ajo.2019.12.022
M3 - Article
C2 - 31926886
AN - SCOPUS:85079656834
SN - 0002-9394
VL - 213
SP - 1
EP - 8
JO - American journal of ophthalmology
JF - American journal of ophthalmology
ER -