Papilledema secondary to internal jugular veins thrombosis in a peritoneal dialysis patient

Abstract

PurposeIntracranial hypertension secondary to internal jugular vein (IJV) thrombosis has been described in patients undergoing hemodialysis with peripheral hemodialysis shunts or repeated subclavian and jugular veins catheterizations. Pseudotumor cerebri, with no identified IJV thrombosis has also been reported in dialysis patients and has been associated with chronic or recurrent dialysis disequilibrium. We aim to report the case of a dialysis patient with papilledema secondary to bilateral IJV thrombosis.MethodsCase report with fundus photography, optical coherence tomography, perimetry, brain imaging with venography, cerebrospinal fluid (CSF) analysis and neck eco Doppler.ResultsA 38‐year‐old man with end stage kidney disease undergoing peritoneal dialysis for 4 years presented with transient blurred vision, lasting a few minutes at a time, exacerbated by positional changes, with no vision loss or other symptoms. Physical examination revealed bilateral disc edema. No other ophthalmologic or neurological signs were found. Head CT with venography was unremarkable. Lumbar puncture CSF opening pressure was 23 cm H2O with normal CSF composition. Humphrey visual field were normal. Posterior neck eco Doppler showed absence of IJV bilaterally, which established the diagnosis.ConclusionsPapilledema secondary to IJV thrombosis may occur in dialysis patients as a result of hemodynamic factors related to arteriovenous fistulas or chest/neck veins catheterization and also in patients undergoing peritoneal dialysis. End stage kidney disease is associated with higher risk of cardiovascular events and IJV thrombosis must be promptly ruled out in patients presenting with altered vision and papilledema.