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[Papilledema and dural fistula]
P Rozot1, J P Berrod, S Bracard
1Service d'Ophtalmologie A, Hôpital Central, Nancy.
Journal Francais D'Ophtalmologie
|January 1, 1991
Summary
Papilledema can be caused by dural arteriovenous malformations, not just idiopathic intracranial hypertension. Venous hypertension from these malformations is the primary cause, necessitating prompt angiologic investigation.
Area of Science:
- Neurology
- Vascular Surgery
- Ophthalmology
Background:
- Idiopathic intracranial hypertension is often diagnosed based on symptoms, normal neurological exams, and standard tests.
- Papilledema, a sign of increased intracranial pressure, can be misdiagnosed.
- Dural arteriovenous malformations (DAVMs) are rare vascular anomalies.
Observation:
- Three cases initially diagnosed with idiopathic intracranial hypertension presented with papilledema.
- Diagnosis of underlying DAVM was delayed, requiring cerebral angiography after six months.
- Standard diagnostic workups including EEG, CT, and CSF analysis were normal.
Findings:
- DAVMs, particularly those with subarachnoid vein drainage, are a significant cause of papilledema.
- Venous hypertension, resulting from venous sinus obstruction and high DAVM blood flow, drives papilledema.
- Intracranial bruit may be absent, delaying diagnosis.
Implications:
- Routine angiologic investigation, including Doppler ultrasound and cerebral angiography, is crucial before diagnosing benign intracranial hypertension.
- Early detection of DAVMs is vital for preventing potential vision loss and serious neurological complications.
- This study highlights the importance of considering vascular causes in papilledema cases.