Garg Anubhav, Rajendram Phavalan, Muccilli Alexandra, Noel de Tilly Lyne, Micieli Jonathan A
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Eur J Ophthalmol. 2020 Nov 11:1120672120970406. doi: 10.1177/1120672120970406.
Idiopathic intracranial hypertension (IIH) is one of the most common causes of papilloedema seen by ophthalmologists and neurologists. Patients with IIH routinely undergo lumbar puncture (LP) for diagnosis. Dural venous sinus thrombosis (DVST) is a rare complication of cerebrospinal fluid pressure (CSF)-lowering procedures such as lumbar puncture and epidural and may be an intracranial complication of IIH.
A 29-year-old obese woman was diagnosed with severe idiopathic intracranial hypertension (IIH) after she presented with new-onset headache, pulsatile tinnitus and blurred vision. Magnetic resonance imaging (MRI) and venography (MRV) were normal apart from signs of intracranial hypertension. Lumbar puncture (LP) revealed an opening pressure of 40 cm of water. Due to the severity of the papilloedema and vision loss, she was referred for a ventriculoperitoneal shunt and found to have venous sinus thrombosis involving the superior sagittal sinus on the pre-operative computed tomography (CT) head 5 days after the LP. CT venography (CTV) one day later and MRV 3 days later showed significant worsening as the thrombosis extended into the deep venous system. She was started on therapeutic heparin and her symptoms and vision improved and she did not develop any neurological complications.
DVST should be considered in IIH patients who have worsening papilloedema or symptoms of intracranial hypertension. Repeat venous imaging can prevent devastating consequences such as venous infarcts of haemorrhage in these patients.
特发性颅内高压（IIH）是眼科医生和神经科医生所见视乳头水肿最常见的病因之一。IIH患者通常会接受腰椎穿刺（LP）以进行诊断。硬脑膜静脉窦血栓形成（DVST）是腰椎穿刺、硬膜外穿刺等降低脑脊液压力（CSF）操作的一种罕见并发症，可能是IIH的一种颅内并发症。
一名29岁肥胖女性，出现新发头痛、搏动性耳鸣和视力模糊后，被诊断为重度特发性颅内高压（IIH）。除颅内高压体征外，磁共振成像（MRI）和静脉造影（MRV）均正常。腰椎穿刺（LP）显示初压为40厘米水柱。由于视乳头水肿和视力丧失的严重程度，她被转诊接受脑室腹腔分流术，并在腰椎穿刺术后5天的术前头颅计算机断层扫描（CT）中发现上矢状窦静脉窦血栓形成。一天后的CT静脉造影（CTV）和三天后的MRV显示，随着血栓扩展至深静脉系统，病情显著恶化。她开始接受肝素治疗，症状和视力有所改善，且未出现任何神经系统并发症。
对于视乳头水肿加重或有颅内高压症状的IIH患者，应考虑DVST。重复静脉成像可预防这些患者出现静脉梗死或出血等严重后果。
