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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...

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Unilateral papilledema: illustrative case.

George A Villatoro¹, Jeffrey S Pannell², Peter J Savino¹

¹Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.

Journal of Neurosurgery. Case Lessons

|November 11, 2024

Summary

Unilateral papilledema, a rare sign of idiopathic intracranial hypertension, can be linked to venous sinus abnormalities. Treating venous sinus stenosis may resolve optic disc swelling in these unique cases.

Keywords:

hypoplastic sinus idiopathic intracranial hypertension unilateral optic disc edema unilateral papilledema venous sinus stenting

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Area of Science:

Neuro-ophthalmology
Neurology
Vascular Neurology

Background:

Idiopathic intracranial hypertension (IIH) typically causes bilateral papilledema and visual loss.
Unilateral papilledema is rare, and its underlying mechanisms are not well understood.
This case explores a rare presentation of IIH with asymmetric optic nerve involvement.

Purpose of the Study:

To investigate the relationship between venous sinus abnormalities and unilateral papilledema in a patient with IIH.
To highlight the diagnostic and therapeutic implications of venous sinus stenosis in IIH.

Main Methods:

A case report of a 42-year-old woman with unilateral papilledema and symptoms of IIH.
Neuroimaging including cerebral arteriography to assess venous sinus anatomy and pressure gradients.
Treatment involved acetazolamide, weight loss, and ultimately, stenting of a stenotic transverse sinus.

Main Results:

The patient presented with left-sided optic disc edema and visual field defects.
Neuroimaging revealed intracranial hypertension with bilateral transverse sinus stenosis and hypoplastic sinuses.
Successful stenting of the right transverse sinus led to resolution of optic disc swelling.

Conclusions:

Venous sinus dynamics play a critical role in the development of unilateral papilledema in IIH.
Identifying and treating venous sinus stenosis can be an effective intervention for IIH with asymmetric optic nerve involvement.
This case underscores the need for individualized treatment approaches in managing IIH.