Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India.
Academy of Eye Care Education, Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India.
Indian J Ophthalmol. 2021 Dec;69(12):3598-3606. doi: 10.4103/ijo.IJO_96_21.
To report clinical profile, diagnostic challenges, and outcomes in cases of subacute/chronic cerebral sinus venous thrombosis (CSVT) presenting to neuro-ophthalmologists/neurologists.
This was a multicentric, retrospective, observational study. Records of patients with neuroimaging proven subacute/chronic CSVT seen the from January 1, 2016 to March 31, 2020 were analyzed. Data collected included duration of symptoms, diagnosing physician, ophthalmological vs. focal/generalized neurological symptoms, optic disc examination, perimetry, and neuroimaging findings. Statistical analysis was performed using STATA software.
Forty-three patients with subacute (30)/chronic (13) CSVT were identified (32 males, 11 females). Median age was 37 (IQR 27-47) years. The presenting complaints were blurred vision 34 (79%), headaches in 25 (58%), vomiting 12 (28%), and diplopia 11 (26%). Eleven patients had associated sixth cranial nerve palsy. All but two patients had either disc edema/optic atrophy; four had unilateral disc edema at presentation. Ophthalmologists and neurologists diagnosed/suspected CSVT correctly in 13/29 (45%) and 11/14 (78.5%) patients, respectively. Most common initial alternate diagnosis was idiopathic intracranial hypertension in 12 (28%). Female gender, age ≤36, unilateral papilledema, not obtaining venogram at initial workup increased chances of initial alternate diagnosis. Median follow-up duration was 21 days. Average visual function remained stable in majority of patients at last follow-up. In total, 47.6% of patients had best-corrected visual acuity ≥20/30 at the final follow-up.
In our series, subacute or chronic CSVT presented presented primarily with symptoms of intracranial hypertension. Unilateral papilledema, middle-aged patients, female gender, lack of focal/generalized neurological symptoms created diagnostic dilemma. Visual function remained stable in majority of patients.
报告神经眼科医生/神经科医生接诊的亚急性/慢性脑窦静脉血栓形成（CSVT）病例的临床特征、诊断挑战和结局。
这是一项多中心、回顾性、观察性研究。分析了 2016 年 1 月 1 日至 2020 年 3 月 31 日期间经神经影像学证实的亚急性/慢性 CSVT 患者的病历。收集的数据包括症状持续时间、诊断医生、眼科与局灶性/全身性神经症状、视盘检查、视野检查和神经影像学发现。使用 STATA 软件进行统计分析。
确定了 43 例亚急性（30 例）/慢性（13 例）CSVT 患者（32 名男性，11 名女性）。中位年龄为 37（IQR 27-47）岁。主要症状为视力模糊 34 例（79%）、头痛 25 例（58%）、呕吐 12 例（28%）和复视 11 例（26%）。11 例患者伴有第六脑神经麻痹。除 2 例患者外，所有患者均有视盘水肿/视神经萎缩；4 例患者在发病时单侧视盘水肿。眼科医生和神经科医生正确诊断/怀疑 CSVT 的患者分别为 13/29（45%）和 11/14（78.5%）。最常见的初始鉴别诊断是特发性颅内高压 12 例（28%）。女性、年龄≤36 岁、单侧视盘水肿、初次检查未行静脉造影术，增加了初始鉴别诊断的可能性。中位随访时间为 21 天。在最后一次随访时，大多数患者的平均视力功能保持稳定。在总共 47.6%的患者中，最终随访时最佳矫正视力≥20/30。
在我们的研究中，亚急性或慢性 CSVT 主要表现为颅内高压的症状。单侧视盘水肿、中年患者、女性、缺乏局灶性/全身性神经症状，导致诊断困难。大多数患者的视力功能保持稳定。
