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 multi-center study included seven 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 Frisen 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. Frisen grade > 3 (odds ratio 10.21, P 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 time of initial diagnosis with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes.