Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis

Katy C. Liu; M. Tariq Bhatti; John J. Chen; Aaron M. Fairbanks; Rod Foroozan; Collin M. McClelland; Michael S. Lee; Celine E. Satija; Courtney E. Francis; Michael T. Wildes; Prem S. Subramanian; Zoë R. Williams; Mays A. El-Dairi

doi:10.1016/j.ajo.2019.12.022

Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis

Katy C. Liu, M. Tariq Bhatti, John J. Chen, Aaron M. Fairbanks, Rod Foroozan, Collin M. McClelland, Michael S. Lee, Celine E. Satija, Courtney E. Francis, Michael T. Wildes, Prem S. Subramanian, Zoë R. Williams, Mays A. El-Dairi

Ophthalmology & Visual Neurosciences

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

PURPOSE: To determine the natural history and visual outcomes of papilledema in cerebral venous sinus thrombosis (CVST).

DESIGN: Retrospective observational case series.

METHODS: This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented papilledema from 2008-2016. Outcome measures included time from diagnosis to papilledema documentation, papilledema progression, time to papilledema resolution, treatment interventions and final visual outcomes.

RESULTS: Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to papilledema documentation was 29 days with a mean (SD) initial Frisén grade of 2.7 (1.3). In 21.5% of cases, papilledema progressed over an average of 55.6 (56.6) days. Time to papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Frisén grade ≥3 (odds ratio [OR] 10.21, P < .0053) and cases with worsening papilledema (3.5, P < .043) were associated with permanent visual field deficits.

CONCLUSIONS: Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes.

Original language	English (US)
Pages (from-to)	1-8
Number of pages	8
Journal	American journal of ophthalmology
Volume	213
DOIs	https://doi.org/10.1016/j.ajo.2019.12.022
State	Published - May 2020

Bibliographical note

Funding Information:
Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center. All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest and the following were reported. Financial Disclosures: Collin M. McClelland is a consultant for ophthoquestions.com (Pukalani, Hawaii). Michael S. Lee received research support from Quark Pharmaceuticals (Newark, CA), received royalties from Springer Publishing (New York, NY) and Uptodate (Waltham, MA), received honoraria from Vindico medical education (Thorofare, NJ) and Projects in Knowledge (Livingston, NJ), and had stock in Horizon Therapeutics. Prem Subramanian is a consultant and received research support from GenSight Biologics (Paris, France) and Quark Pharmaceuticals, received research support from Santhera Pharmaceuticals (Pratteln, Switzerland), was a consultant for Horizon Therapeutics (Dublin, Ireland), was an expert witness for various legal firms, and received royalties from Wolters Kluwer (Alphen aan den Rijn, Netherlands) and Springer. All authors attest that they meet the current ICMJE requirements to qualify as authors.

Funding Information:
Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center .

Publisher Copyright:
© 2020 Elsevier Inc.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

Adolescent
Adult
Aged
Child
Disease Progression
Female
Humans
Male
Middle Aged
Ophthalmoscopy
Papilledema/diagnosis
Retrospective Studies
Risk Factors
Sinus Thrombosis, Intracranial/diagnosis
Time Factors
Vision Disorders/diagnosis
Visual Acuity/physiology
Visual Field Tests
Visual Fields/physiology
Young Adult

PubMed: MeSH publication types

Research Support, Non-U.S. Gov't
Multicenter Study
Journal Article

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10.1016/j.ajo.2019.12.022

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Liu, K. C., Bhatti, M. T., Chen, J. J., Fairbanks, A. M., Foroozan, R., McClelland, C. M., Lee, M. S., Satija, C. E., Francis, C. E., Wildes, M. T., Subramanian, P. S., Williams, Z. R., & El-Dairi, M. A. (2020). Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis. American journal of ophthalmology, 213, 1-8. https://doi.org/10.1016/j.ajo.2019.12.022

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title = "Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis",

abstract = "PURPOSE: To determine the natural history and visual outcomes of papilledema in cerebral venous sinus thrombosis (CVST).DESIGN: Retrospective observational case series.METHODS: This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented papilledema from 2008-2016. Outcome measures included time from diagnosis to papilledema documentation, papilledema progression, time to papilledema resolution, treatment interventions and final visual outcomes.RESULTS: Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to papilledema documentation was 29 days with a mean (SD) initial Fris{\'e}n grade of 2.7 (1.3). In 21.5% of cases, papilledema progressed over an average of 55.6 (56.6) days. Time to papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Fris{\'e}n grade ≥3 (odds ratio [OR] 10.21, P < .0053) and cases with worsening papilledema (3.5, P < .043) were associated with permanent visual field deficits.CONCLUSIONS: Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes.",

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author = "Liu, {Katy C.} and Bhatti, {M. Tariq} and Chen, {John J.} and Fairbanks, {Aaron M.} and Rod Foroozan and McClelland, {Collin M.} and Lee, {Michael S.} and Satija, {Celine E.} and Francis, {Courtney E.} and Wildes, {Michael T.} and Subramanian, {Prem S.} and Williams, {Zo{\"e} R.} and El-Dairi, {Mays A.}",

note = "Funding Information: Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center. All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest and the following were reported. Financial Disclosures: Collin M. McClelland is a consultant for ophthoquestions.com (Pukalani, Hawaii). Michael S. Lee received research support from Quark Pharmaceuticals (Newark, CA), received royalties from Springer Publishing (New York, NY) and Uptodate (Waltham, MA), received honoraria from Vindico medical education (Thorofare, NJ) and Projects in Knowledge (Livingston, NJ), and had stock in Horizon Therapeutics. Prem Subramanian is a consultant and received research support from GenSight Biologics (Paris, France) and Quark Pharmaceuticals, received research support from Santhera Pharmaceuticals (Pratteln, Switzerland), was a consultant for Horizon Therapeutics (Dublin, Ireland), was an expert witness for various legal firms, and received royalties from Wolters Kluwer (Alphen aan den Rijn, Netherlands) and Springer. All authors attest that they meet the current ICMJE requirements to qualify as authors. Funding Information: Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center . Publisher Copyright: {\textcopyright} 2020 Elsevier Inc. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = may,

doi = "10.1016/j.ajo.2019.12.022",

language = "English (US)",

volume = "213",

pages = "1--8",

journal = "American journal of ophthalmology",

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T1 - Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis

AU - Liu, Katy C.

AU - Bhatti, M. Tariq

AU - Chen, John J.

AU - Fairbanks, Aaron M.

AU - Foroozan, Rod

AU - McClelland, Collin M.

AU - Lee, Michael S.

AU - Satija, Celine E.

AU - Francis, Courtney E.

AU - Wildes, Michael T.

AU - Subramanian, Prem S.

AU - Williams, Zoë R.

AU - El-Dairi, Mays A.

N1 - Funding Information: Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center. All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest and the following were reported. Financial Disclosures: Collin M. McClelland is a consultant for ophthoquestions.com (Pukalani, Hawaii). Michael S. Lee received research support from Quark Pharmaceuticals (Newark, CA), received royalties from Springer Publishing (New York, NY) and Uptodate (Waltham, MA), received honoraria from Vindico medical education (Thorofare, NJ) and Projects in Knowledge (Livingston, NJ), and had stock in Horizon Therapeutics. Prem Subramanian is a consultant and received research support from GenSight Biologics (Paris, France) and Quark Pharmaceuticals, received research support from Santhera Pharmaceuticals (Pratteln, Switzerland), was a consultant for Horizon Therapeutics (Dublin, Ireland), was an expert witness for various legal firms, and received royalties from Wolters Kluwer (Alphen aan den Rijn, Netherlands) and Springer. All authors attest that they meet the current ICMJE requirements to qualify as authors. Funding Information: Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center . Publisher Copyright: © 2020 Elsevier Inc. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/5

Y1 - 2020/5

N2 - PURPOSE: To determine the natural history and visual outcomes of papilledema in cerebral venous sinus thrombosis (CVST).DESIGN: Retrospective observational case series.METHODS: This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented papilledema from 2008-2016. Outcome measures included time from diagnosis to papilledema documentation, papilledema progression, time to papilledema resolution, treatment interventions and final visual outcomes.RESULTS: Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to papilledema documentation was 29 days with a mean (SD) initial Frisén grade of 2.7 (1.3). In 21.5% of cases, papilledema progressed over an average of 55.6 (56.6) days. Time to papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Frisén grade ≥3 (odds ratio [OR] 10.21, P < .0053) and cases with worsening papilledema (3.5, P < .043) were associated with permanent visual field deficits.CONCLUSIONS: Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes.

AB - PURPOSE: To determine the natural history and visual outcomes of papilledema in cerebral venous sinus thrombosis (CVST).DESIGN: Retrospective observational case series.METHODS: This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented papilledema from 2008-2016. Outcome measures included time from diagnosis to papilledema documentation, papilledema progression, time to papilledema resolution, treatment interventions and final visual outcomes.RESULTS: Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to papilledema documentation was 29 days with a mean (SD) initial Frisén grade of 2.7 (1.3). In 21.5% of cases, papilledema progressed over an average of 55.6 (56.6) days. Time to papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Frisén grade ≥3 (odds ratio [OR] 10.21, P < .0053) and cases with worsening papilledema (3.5, P < .043) were associated with permanent visual field deficits.CONCLUSIONS: Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes.

KW - Adolescent

KW - Adult

KW - Aged

KW - Child

KW - Disease Progression

KW - Female

KW - Humans

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KW - Middle Aged

KW - Ophthalmoscopy

KW - Papilledema/diagnosis

KW - Retrospective Studies

KW - Risk Factors

KW - Sinus Thrombosis, Intracranial/diagnosis

KW - Time Factors

KW - Vision Disorders/diagnosis

KW - Visual Acuity/physiology

KW - Visual Field Tests

KW - Visual Fields/physiology

KW - Young Adult

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JF - American journal of ophthalmology

ER -

Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

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