Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report
Abstract Background Papilledema is a common sign of various diseases in the eye. It could result from any conditions of increased intracranial pressure (ICP). Underlying the etiology of papilledema and appropriate treatment in time is essential. Case report We present a case of severe bilateral papi...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Ophthalmology |
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| Online Access: | https://doi.org/10.1186/s12886-023-03252-1 |
| _version_ | 1797398084493246464 |
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| author | Xi Chen Yizhou Ren Fang Chen |
| author_facet | Xi Chen Yizhou Ren Fang Chen |
| author_sort | Xi Chen |
| collection | DOAJ |
| description | Abstract Background Papilledema is a common sign of various diseases in the eye. It could result from any conditions of increased intracranial pressure (ICP). Underlying the etiology of papilledema and appropriate treatment in time is essential. Case report We present a case of severe bilateral papilledema after sigmoid sinus constriction surgery. A 25-year-old female presented with a 1-month history of bilateral blurred vision, headache, and vomiting. The patient had a history of right-side sigmoid sinus constriction surgery for pulsatile tinnitus (PT) one month before in another hospital. Fundus examination showed severe bilateral papilledema. Lumbar puncture showed an elevated cerebrospinal fluid (CSF) opening pressure of 29 cm H2O. Neuroimaging examination demonstrated the right sigmoid sinus filling defect as changes after surgery. We referred the patient to the initial surgeon, who repaired the sigmoid sinus on the right side by removing the implanted gelatin sponge, as diuretic treatment could not be effective. Intracranial hypertension symptoms and signs improved soon after eliminating sigmoid sinus stenosis. Neuroimaging showed resolved right sigmoid sinus stenosis after the second surgery. CSF opening pressure was 14.5 cm H2O at the 1-month follow-up. Fundus examination showed entirely resolved papilledema. Three years of follow-up showed no recurrence. Conclusions This is the first clinical report of intracranial hypertension associated with sigmoid sinus constriction surgery. Although rare, rapid detection and adequate etiology management could lead to a good prognosis. It highlights the need for ophthalmologists to be aware of the diagnostic approach to papilledema and enhance cooperation with multidisciplinary departments. The most likely cause of the intracranial hypertension was dominant sinus surgical constriction by mechanical external compression, as confirmed by the complete clinical remission following the second operation to remove the implanted gelatin sponge. Thus, this case also highlights the importance of selecting the appropriate therapeutic option for PT. Surgical sinus constriction should no longer be considered a viable option for PT treatment. |
| first_indexed | 2024-03-09T01:20:35Z |
| format | Article |
| id | doaj.art-878c1ba720234e4ab112aa2de07e3156 |
| institution | Directory Open Access Journal |
| issn | 1471-2415 |
| language | English |
| last_indexed | 2024-03-09T01:20:35Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj.art-878c1ba720234e4ab112aa2de07e31562023-12-10T12:11:35ZengBMCBMC Ophthalmology1471-24152023-12-012311710.1186/s12886-023-03252-1Severe bilateral papilledema after sigmoid sinus constriction surgery: a case reportXi Chen0Yizhou Ren1Fang Chen2Department of Ophthalmology, Northern Jiangsu People’s HospitalDepartment of Ophthalmology, Northern Jiangsu People’s HospitalDepartment of Ophthalmology, Northern Jiangsu People’s HospitalAbstract Background Papilledema is a common sign of various diseases in the eye. It could result from any conditions of increased intracranial pressure (ICP). Underlying the etiology of papilledema and appropriate treatment in time is essential. Case report We present a case of severe bilateral papilledema after sigmoid sinus constriction surgery. A 25-year-old female presented with a 1-month history of bilateral blurred vision, headache, and vomiting. The patient had a history of right-side sigmoid sinus constriction surgery for pulsatile tinnitus (PT) one month before in another hospital. Fundus examination showed severe bilateral papilledema. Lumbar puncture showed an elevated cerebrospinal fluid (CSF) opening pressure of 29 cm H2O. Neuroimaging examination demonstrated the right sigmoid sinus filling defect as changes after surgery. We referred the patient to the initial surgeon, who repaired the sigmoid sinus on the right side by removing the implanted gelatin sponge, as diuretic treatment could not be effective. Intracranial hypertension symptoms and signs improved soon after eliminating sigmoid sinus stenosis. Neuroimaging showed resolved right sigmoid sinus stenosis after the second surgery. CSF opening pressure was 14.5 cm H2O at the 1-month follow-up. Fundus examination showed entirely resolved papilledema. Three years of follow-up showed no recurrence. Conclusions This is the first clinical report of intracranial hypertension associated with sigmoid sinus constriction surgery. Although rare, rapid detection and adequate etiology management could lead to a good prognosis. It highlights the need for ophthalmologists to be aware of the diagnostic approach to papilledema and enhance cooperation with multidisciplinary departments. The most likely cause of the intracranial hypertension was dominant sinus surgical constriction by mechanical external compression, as confirmed by the complete clinical remission following the second operation to remove the implanted gelatin sponge. Thus, this case also highlights the importance of selecting the appropriate therapeutic option for PT. Surgical sinus constriction should no longer be considered a viable option for PT treatment.https://doi.org/10.1186/s12886-023-03252-1PapilledemaIntracranial HypertensionPulsating tinnitusSigmoid sinus constriction SurgerySigmoid sinus stenosisCase report |
| spellingShingle | Xi Chen Yizhou Ren Fang Chen Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report BMC Ophthalmology Papilledema Intracranial Hypertension Pulsating tinnitus Sigmoid sinus constriction Surgery Sigmoid sinus stenosis Case report |
| title | Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report |
| title_full | Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report |
| title_fullStr | Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report |
| title_full_unstemmed | Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report |
| title_short | Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report |
| title_sort | severe bilateral papilledema after sigmoid sinus constriction surgery a case report |
| topic | Papilledema Intracranial Hypertension Pulsating tinnitus Sigmoid sinus constriction Surgery Sigmoid sinus stenosis Case report |
| url | https://doi.org/10.1186/s12886-023-03252-1 |
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