Zhao Tongtao, Wang Gang, Dai Jiaman, Liu Yong, Wang Yi, Li Shiying
Department of Ophthalmology, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China.
Aier Eye Hospital, Chongqing, China.
BMC Neurol. 2018 Sep 29;18(1):159. doi: 10.1186/s12883-018-1156-7.
Cerebral venous sinus thrombosis or stenosis (here collectively referred to as cerebral venous sinus occlusion, CVSO) can cause chronically-elevated intracranial pressure (ICP). Patients may have no neurological symptoms other than visual impairment, secondary to bilateral papilledema. Correctly recognizing these conditions, through proper ophthalmological examination and brain imaging, is very important to avoid delayed diagnosis and treatment.
We report a case series of 3 patients with chronic CVSO, who were admitted to an ophthalmological department in Chongqing, China, from 2015 March to 2017 February. All patients presented with decreased vision and bilateral papilledema, but had no headache or other neurological symptoms. The visual fields of all patients were impaired. Flash visual evoked potentials (VEPs) in two patients showed essentially normal peak time of P2 wave, and pattern VEPs in one patient displayed decreased P100 amplitude in one eye, while a normal P100 wave in the other eye. In all patients, lumbar puncture (LP) revealed significantly elevated ICP. And magnetic resonance venography (MRV) demonstrated cerebral venous sinus abnormalities in every patient: one right sigmoid sinus thrombosis, one superior sagittal sinus thrombosis, and one right transverse sinus stenosis.
CVSO can cause chronically-elevated ICP, leading to bilateral papilledema and visual impairment. A considerable amount of patients have no apparent neurological symptoms other than visual loss. Unlike other optic nerve lesions, such as neuritis or ischemic optic neuropathy, the optic disc edema in CVSO is usually bilateral, the flash or pattern VEP is often normal or only mildly affected, and patients are often not sensitive to steroid therapy. CVSO should be suspected in such patients when unenhanced brain imaging is normal. Further investigations, such as LP and contrast-enhanced imaging (MRV and digital subtraction angiography), should be performed to diagnose or exclude CVSO.
脑静脉窦血栓形成或狭窄（在此统称为脑静脉窦闭塞，CVSO）可导致颅内压（ICP）长期升高。患者除因双侧视乳头水肿继发视力障碍外，可能无其他神经症状。通过适当的眼科检查和脑部影像学检查正确识别这些情况，对于避免延迟诊断和治疗非常重要。
我们报告了一组3例慢性CVSO患者的病例系列，这些患者于2015年3月至2017年2月在中国重庆的一家眼科就诊。所有患者均表现为视力下降和双侧视乳头水肿，但无头痛或其他神经症状。所有患者的视野均受损。两名患者的闪光视觉诱发电位（VEP）显示P2波峰时间基本正常，一名患者的图形VEP显示一只眼的P100波幅降低，而另一只眼的P100波正常。所有患者的腰椎穿刺（LP）显示ICP显著升高。磁共振静脉造影（MRV）显示每位患者均有脑静脉窦异常：1例右侧乙状窦血栓形成，1例上矢状窦血栓形成，1例右侧横窦狭窄。
CVSO可导致ICP长期升高，导致双侧视乳头水肿和视力障碍。相当一部分患者除视力丧失外无明显神经症状。与其他视神经病变，如神经炎或缺血性视神经病变不同，CVSO中的视盘水肿通常是双侧的，闪光或图形VEP通常正常或仅轻度受影响，并且患者通常对类固醇治疗不敏感。当未增强的脑部影像学检查正常时，应怀疑此类患者患有CVSO。应进行进一步检查，如LP和增强成像（MRV和数字减影血管造影），以诊断或排除CVSO。
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