Kulkarni Girish Baburao, Singh Ravinder Jeet, Gadad Veeranna, Ramakrishnan Subasree, Mustare Veerendrakumar
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
J Neurosci Rural Pract. 2017 Aug;8(Suppl 1):S106-S110. doi: 10.4103/jnrp.jnrp_156_17.
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.
在大多数颅内压升高的患者中，视乳头水肿是双侧性的。在引起颅内高压的疾病中，单侧视乳头水肿很少见，曾在福斯特 - 肯尼迪综合征及一些特发性颅内高压病例中有所描述。在脑静脉血栓形成中从未有过相关报道。我们报告一位年轻女性，表现为亚急性起病的头痛伴癫痫发作，经评估她患有上矢状窦及双侧横窦血栓形成。评估发现的危险因素为维生素B12缺乏和高同型半胱氨酸血症。眼底检查时，她右侧视盘肿胀，左侧眼底正常，眼眶超声B超扫描及光学相干断层扫描证实了这一点。她的磁共振成像显示有颅内压升高的特征以及上矢状窦和双侧横窦血栓形成。她接受了抗凝治疗（先使用肝素，随后口服抗凝剂）、抗水肿措施以及针对高同型半胱氨酸血症的维生素补充治疗。随着时间推移她病情好转，随访期间无症状。我们讨论了文献中描述的单侧视乳头水肿的可能机制。本报告强调了仔细进行双侧眼底检查的必要性，以免漏诊导致头痛的视力或危及生命的病因。
