Fate of Papilledema in Cerebral Venous Thrombosis Patients and its Correlation to Affected Cerebral Venous Sinuses

Abstract

Background: Cerebral venous thrombosis is an important cause of stroke in young and middle-aged adults with estimated (3-4) cases per million annual incidences. Papilledema is the most common sign detected in these patients that can end by blindness if not monitored and treated well. This research aims to assess development and prognosis of papilledema and its association with certain cerebral venous sinuses thrombosis. Evaluation of the optic nerve head has been done clinically and by using optical coherence tomography. Methods: A descriptive analytic hospital-based study was conducted in neurology unit at wad medani teaching hospital from December 2021 to July 2022. 20 patients were included in the study. Data including optical coherence tomography reports was collected at admission and after 2 months. Analysis was done using SPSS version 25 to report frequency of papilledema, 2months visual outcome, correlation of MRI\MRV findings with the development and outcome of papilledema. Results: This study include 20 cerebral venous thrombosis patients with mean age of 35.75 years. Papilledema present in 70% at initial presentation in whom the superior sagittal sinus was affected in 78.6%, after two months period papilledema regressed in80%, 10% developed optic atrophy and10% died. There is clear correlation between the sinus affected and the development of papilledema (P value=0.009); in contrast no relation between the sinus affected and the two months visual outcome of papilledema (P value=0.417). Conclusion: Papilledema regressed in most CVT patients while small number of them developed optic atrophy confirming the importance of regular ophthalmological follow up of CVT patients at frequent intervals using OCT in addition to other papilledema assessment tools in order to prevent irreversible blindness. Affection of certain cerebral venous sinus can predict development of papilledema in CVT patients, but not the outcome.