Papilledema and Venous Sinus Thrombosis

Cerebral venous sinus thrombosis is a rare form of embolic stroke affecting the cerebral venous system. It is postulated that sinus thrombosis causes occlusion of the venous sinus, retrograde or backup of blood, and eventually papilledema with potential for neurological damage and even death (Xie et al., Surv Ophthalmol 67(4):1135–1159, 2022). The term “papilledema” refers to bilateral disc edema caused by increased intracranial pressure. Common causes include uncontrolled hypertension, significant weight gain, obstructive hydrocephalus, and intracranial tumors (Ehlers and Shah, The Wills eye manual: office and emergency room diagnosis and treatment of eye disease. Lippincott Williams & Wilkins, Baltimore, 2008). When papilledema is suspected or seen, further evaluation is warranted because vision loss can result if the underlying cause is not identified and treated. Further testing should include magnetic resonance imaging (MRI) of the brain and spine, magnetic resonance venography (MRV) of the brain, and a lumbar puncture to rule out an infectious etiology. Particular attention should be paid to the opening pressure during the lumbar puncture. Current treatment of elevated intracranial pressure can range from medications, weight loss, or surgery depending on the etiology.