Jiang Ligang, Jiang Xin, Li Ailian, Liu Mengting, Zhang Zhe, Tong Yuhua
Department of Ophthalmology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
Quzhou College of Technology, Quzhou, China.
Front Med (Lausanne). 2025 Jul 4;12:1636933. doi: 10.3389/fmed.2025.1636933. eCollection 2025.
To analyze a case of atypical bilateral papilledema in a puerperium woman, and to explore the pathogenic mechanism of pregnancy-related physiological changes, blood hypercoagulable state, immune abnormalities and abnormal structure of intracranial venous sinus, so as to provide reference for early diagnosis and intervention of similar cases.
A 28-year-old woman, 3 days post-operative from a cesarean section, presented at the hospital with decreased vision in her right eye. An examination revealed bilateral papilledema. She did not have typical symptoms like dizziness, headache, or pulsatile tinnitus. During pregnancy, she had taken hydroxychloroquine orally for 5 months due to elevated immune indexes. She also received anticoagulant therapy for lower extremity venous thrombosis a month prior and had a history of cerebrospinal fluid leakage repair for intracranial hypotension syndrome a year ago. Fundus photography and OCT showed bilateral papilledema and macular edema in the right eye, with slightly enlarged physiological blind spots in both eyes. Her pre-pregnancy BMI was 16.5, and postpartum BMI was 22. Laboratory tests indicated a D-dimer level exceeding 20 mg/L and abnormal immune indicators. Ophthalmic color Doppler ultrasound demonstrated bilateral optic nerve sheath widening, with measurements of 0.625 cm on the right and 0.590 cm on the left, suggesting potential elevated intracranial pressure. MRV detected stenosis in the right distal sigmoid sinus and proximal transverse sinus, while the left sigmoid sinus and transverse sinus were not visualized. The patient was diagnosed with increased intracranial pressure caused by multiple factors. Treatment with mannitol to reduce intracranial pressure, along with anticoagulation and other supportive and symptomatic treatments, was administered. After 1 week, macular edema in the right eye subsided, vision improved, and bilateral papilledema slowly improved.
This case provides multi-dimensional clinical evidence for the differential diagnosis of puerperium papilledema. For patients with low BMI and atypical symptoms of bilateral papilledema during puerperium, it is necessary to be alert to multiple pathogenic factors. It is recommended to preferentially screen intracranial venous sinus lesions and detect immune indicators by imaging. Ocular ultrasound can be used as a non-invasive screening method for intracranial hypertension.
分析1例产褥期妇女非典型双侧视乳头水肿病例，探讨妊娠相关生理变化、血液高凝状态、免疫异常及颅内静脉窦结构异常的致病机制，为类似病例的早期诊断和干预提供参考。
一名28岁女性，剖宫产术后3天，因右眼视力下降入院。检查发现双侧视乳头水肿。她没有头晕、头痛或搏动性耳鸣等典型症状。孕期因免疫指标升高口服羟氯喹5个月。1个月前因下肢静脉血栓接受抗凝治疗，1年前有颅内低压综合征脑脊液漏修补病史。眼底照相和光学相干断层扫描显示双侧视乳头水肿及右眼黄斑水肿，双眼生理盲点略增大。孕前体重指数（BMI）为16.5，产后BMI为22。实验室检查显示D-二聚体水平超过20mg/L，免疫指标异常。眼科彩色多普勒超声显示双侧视神经鞘增宽，右侧测量值为0.625cm，左侧为0.590cm，提示颅内压可能升高。磁共振静脉血管造影（MRV）检测到右侧乙状窦远端和横窦近端狭窄，左侧乙状窦和横窦未显影。患者被诊断为多因素导致的颅内压升高。给予甘露醇降低颅内压，并进行抗凝及其他支持对症治疗。1周后，右眼黄斑水肿消退，视力改善，双侧视乳头水肿缓慢好转。
本病例为产褥期视乳头水肿的鉴别诊断提供了多维度临床证据。对于产褥期BMI低且有非典型双侧视乳头水肿症状的患者，需警惕多种致病因素。建议优先筛查颅内静脉窦病变并通过影像学检测免疫指标。眼部超声可作为颅内高压的无创筛查方法。
