Cioana Milena, Ranalli Paul J, Micieli Jonathan A
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Case Rep Ophthalmol. 2022 Mar 17;13(1):185-190. doi: 10.1159/000522637. eCollection 2022 Jan-Apr.
Coronavirus disease-19 (COVID-19) patients are at an increased risk of cerebral venous sinus thrombosis (CVST). Rapid diagnosis and treatment are vital to ensure a favorable outcome for CVST, so clinicians need to be aware of all its potential presentations. We describe a unique case where transient visual obscurations (TVOs) from papilledema were the presenting symptoms of COVID-19-related CVST. A 43-year-old woman, who had tested positive for severe acute respiratory syndrome coronavirus-2 1 month earlier, developed holocephalic headache, TVOs, and bilateral disc edema. She did not seek medical attention until she developed TVOs. Visual acuity was 20/20 and Humphrey visual field testing showed enlarged blind spots in both eyes. She was diagnosed with papilledema and underwent magnetic resonance imaging and magnetic resonance venography of the brain, which revealed right transverse sinus thrombosis. Lumbar puncture was performed, showing elevated opening pressure and normal cerebrospinal fluid contents. Her optic disc edema resolved and visual function remained normal 6 weeks following warfarin and topiramate therapy. Recanalization of the right transverse sinus occurred after 3 months. Although rare, TVOs are important presenting symptoms of COVID-19-related CVST. Ophthalmologists, who may be the first physicians to assess patients with this presentation, should be aware of TVOs as potential presenting symptoms of CVST, so diagnoses can be made in a timely manner.
新型冠状病毒肺炎（COVID-19）患者发生脑静脉窦血栓形成（CVST）的风险增加。快速诊断和治疗对于确保CVST获得良好预后至关重要，因此临床医生需要了解其所有可能的表现形式。我们描述了一例独特的病例，视乳头水肿导致的短暂性视力模糊（TVOs）是COVID-19相关CVST的首发症状。一名43岁女性，1个月前严重急性呼吸综合征冠状病毒2检测呈阳性，出现全头性头痛、TVOs和双侧视盘水肿。直到出现TVOs她才就医。视力为20/20，汉弗莱视野检查显示双眼盲点扩大。她被诊断为视乳头水肿，并接受了脑部磁共振成像和磁共振静脉造影，结果显示右侧横窦血栓形成。进行了腰椎穿刺，结果显示初压升高，脑脊液成分正常。华法林和托吡酯治疗6周后，她的视盘水肿消退，视觉功能保持正常。3个月后右侧横窦再通。尽管罕见，但TVOs是COVID-19相关CVST的重要首发症状。眼科医生可能是首批评估有此表现患者的医生，应意识到TVOs作为CVST潜在首发症状的可能性，以便能及时做出诊断。
