Papilledema due to cerebral venous thrombosis

Abstract

Abstract Purpose Review the clinical features and the most effective method of diagnosis of cerebral dural venous sinus thrombosis (CDVT). Treatment procedure of the predisposing factors and of the cerebral thrombosis will be briefly discuss. Methods Recent litterature is considered Results CVDT is a challenging condition because the variability of clinical presentations. It might mimic many neurological disorders such as, meningitis, intracranial hypertension, encephalopathy and stroke. However, the most common pattern of presentation is with a pseudotumor cerebri like syndrome: headache, nausea, vomiting, papilledema, optic‐nerve related visual loss, and VI nerve palsies. CVDT can present at all ages, but is seen more in young and middle‐aged women. The most frequent predisposing factor is a hypercoagulable state, although contiguous infection, like mastoiditis or middle‐ear infections, and neoplasms should be excluded. MRI with gadolinium and MR venography are a safe and effective method for visualizing cerebral venous thrombosis. Treatment should be firstly direct toward any underlying medical condition, and any offending drug should be discontinued. Anticoagulation should be started with IV heparin, and usually followed by warfarin. Acetazolamide might be used to treat elevated intracranial pressure and mild field defect. Those with progressive or severe visual loss, despite medical therapy, should undergo optic nerve fenestration or other shunting procedure. Conclusion One should keep in mind the possibility of CDVT in every patient with new‐onset headache of any type, particularly if worsening despite analgesic. Earlier the diagnosis, earlier the treatment, better is the outcome.