Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis

• Published in: Indian journal of ophthalmology 2021-12, Vol.69 (12), p.3598-3606
• Main Authors: Sachdeva, Virender, Nalawade, Rohan, Kannam, Mohan, Kapoor, Rajat, Chattannavar, Goura, Kale, Sheetal, Sheth, Jenil, Badakere, Akshay, Majhi, Debasmita, Warkad, Vivekanand, Chougule, Pratik, Kekunnaya, Ramesh
• Format: Article
• Language: English
• Subjects: Abducens nerve; Acuity; Adult; Atrophy; Care and treatment; Cerebral embolism and thrombosis; cerebral sinus venous thrombosis; chronic; Cranial nerves; Diagnosis; diagnostic challenges; Edema; Female; Females; Gender; Humans; Hypertension; Image processing; Intracranial Hypertension; Male; Medical imaging; Medical personnel; Middle Aged; Neuroimaging; Neurologic manifestations of general diseases; Optic atrophy; Optic nerve; outcomes subacute; Papilledema - diagnosis; Papilledema - epidemiology; Paralysis; Patient outcomes; Patients; Retrospective Studies; Sinus Thrombosis, Intracranial - diagnosis; Sinus Thrombosis, Intracranial - epidemiology; Special Focus, Neuroophthalmology, Original; Statistical analysis; Swelling; Thrombosis; Venous Thrombosis; Visual perception; Vomiting
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_96_21

Purpose: To report clinical profile, diagnostic challenges, and outcomes in cases of subacute/chronic cerebral sinus venous thrombosis (CSVT) presenting to neuro-ophthalmologists/neurologists. Methods: This was a multicentric, retrospective, observational study. Records of patients with neuroimaging proven subacute/chronic CSVT seen the from January 1, 2016 to March 31, 2020 were analyzed. Data collected included duration of symptoms, diagnosing physician, ophthalmological vs. focal/generalized neurological symptoms, optic disc examination, perimetry, and neuroimaging findings. Statistical analysis was performed using STATA software. Results: Forty-three patients with subacute (30)/chronic (13) CSVT were identified (32 males, 11 females). Median age was 37 (IQR 27-47) years. The presenting complaints were blurred vision 34 (79%), headaches in 25 (58%), vomiting 12 (28%), and diplopia 11 (26%). Eleven patients had associated sixth cranial nerve palsy. All but two patients had either disc edema/optic atrophy; four had unilateral disc edema at presentation. Ophthalmologists and neurologists diagnosed/suspected CSVT correctly in 13/29 (45%) and 11/14 (78.5%) patients, respectively. Most common initial alternate diagnosis was idiopathic intracranial hypertension in 12 (28%). Female gender, age ≤36, unilateral papilledema, not obtaining venogram at initial workup increased chances of initial alternate diagnosis. Median follow-up duration was 21 days. Average visual function remained stable in majority of patients at last follow-up. In total, 47.6% of patients had best-corrected visual acuity ≥20/30 at the final follow-up. Conclusion: In our series, subacute or chronic CSVT presented presented primarily with symptoms of intracranial hypertension. Unilateral papilledema, middle-aged patients, female gender, lack of focal/generalized neurological symptoms created diagnostic dilemma. Visual function remained stable in majority of patients.