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Case Reports
. 2023 Aug 20;15(8):e43828.
doi: 10.7759/cureus.43828. eCollection 2023 Aug.

A Case of Bilateral Papilledema With Improved Clinical Symptoms by Venous Stenting for Superior Sagittal Sinus Stenosis

Masaki Miyoshi  1 , Akio Tabuchi  2 , Osamu Mimura  3 , Atsufumi Nagahama  4 , Hitoshi Tabuchi  5
Affiliations
Case Reports

A Case of Bilateral Papilledema With Improved Clinical Symptoms by Venous Stenting for Superior Sagittal Sinus Stenosis

Masaki Miyoshi et al. Cureus. .

Abstract

Superior sagittal sinus (SSS) obstruction causes intracranial hypertension, often requiring surgical stenting. Consensus on treating brain venous sinus stenosis, another cause, is lacking. This study reports a case of SSS stenosis and intracranial hypertension treated with venous stenting, improving bilateral papilledema. A 51-year-old with a headache and visual disturbance had papilledema and visual field loss. MR venography showed SSS stenosis, leading to a neurosurgery referral. Lumbar puncture confirmed intracranial hypertension (>35 cmH2O), prompting venous stenting. Post-procedure, papilledema, headache, and visual field loss improved. Venous stenting could be effective for SSS stenosis with clinically proven or recurrent pressure differences. Further cases are needed for standardization.

Keywords: intracranial hypertension; papilledema; sss; superior sagittal sinus stenosis; venous stenting.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Papillary findings and papillary OCT findings at the first examination
A. A color photograph of the posterior fundi: Prominent reddening of optic papillae is noted in both eyes, with the borders being irregular. B. Papillary OCT images: Prominent swelling of optic papillae is noted in both eyes.
Figure 2
Figure 2. Humphrey visual field (30-2 program) at first examination
Right eye (top), Left eye (bottom) Static visual field test: A hemianopia-like visual field defect was noted in the lower left eye.
Figure 3
Figure 3. Humphrey visual field and papillary OCT findings three weeks after starting steroid pulse therapy
A. Static visual field test: The visual field defect in the left eye slightly improved. B. Papillary OCT images: The mild swelling in both eyes improved.
Figure 4
Figure 4. Cranial MRI and MRV
A. MRI T2 FLAIR image: Neither intracranial space-occupying lesions nor cerebral ventriculomegaly were observed. B. MR venography: The arrows indicate superior sagittal sinus stenosis sites
Figure 5
Figure 5. Six months after the first examination
Right eye (top), Left eye (bottom) Static visual field test: A visual field defect was also noted in the lower right eye.
Figure 6
Figure 6. Photography of the left internal carotid artery, a venous-phase lateral image
(1) Proximal stenosis site, (2) narrowest stenosis site, and (3) distal stenosis site.
Figure 7
Figure 7. After stent placement
A. Static visual field test: Changes in the visual field improved in both eyes, albeit with partial remnants. B. Optic papillary OCT: Swelling in both eyes apparently improved
See this image and copyright information in PMC

References

    1. EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Einhäupl K, Bousser MG, de Bruijn SF, Ferro JM, Martinelli I, Masuhr F, Stam J. Eur J Neurol. 2006;13:553–559. - PubMed
    1. Cerebral venous thrombosis: a practical guide. Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Pract Neurol. 2020;20:356–367. - PubMed
    1. Causes and predictors of death in cerebral venous thrombosis. Canhão P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F. Stroke. 2005;36:1720–1725. - PubMed
    1. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Saposnik G, Barinagarrementeria F, Brown RD Jr, et al. Stroke. 2011;42:1158–1192. - PubMed
    1. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Radiographics. 2006;26 Suppl 1:0–3. - PubMed

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