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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.
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.
