Jiayue Ding1,2,3, Da Zhou1,2,3, Tingting Geng1,2,3, Liqun Pan1,2,3, Jingyuan Ya1,2,3, Zhongao Wang1,2,3, Yanyu Hu1,2,3, Yuchuan Ding2,4, Xuxiang Zhang1,3, Ran Meng5,6,7. 1. Departments of Neurology and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China. 2. Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China. 3. Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. 4. Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA. 5. Departments of Neurology and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, Chinaranmeng2011@pku.org.cn. 6. Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, Chinaranmeng2011@pku.org.cn. 7. Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, Chinaranmeng2011@pku.org.cn.
Abstract
BACKGROUND: Visual damage is one of the most common complications of cerebral venous sinus thrombosis (CVST)-associated intracranial hypertension (IH). This study is aimed at stratifying the risk of IH-induced visual damage in an attempt to predict its deterioration and prevent high-risk patients from irreversible eyesight impairment promptly. METHODS: A total of 94 patients with confirmed diagnosis of CVST were eligible for enrollment in this study. According to cerebrospinal fluid pressure at admission, the involved patients were classified into mild IH (< 250 mmH2O), moderate IH (250-330 mmH2O), and severe IH (≥330 mmH2O) groups. RESULTS: The ratio of visual deterioration in the severe IH group was 75%, which was significantly higher than in either the moderate (44.4%) or the mild groups (14.3%). As regards subjects without visual symptoms at admission, visual deterioration occurred in 9.4 ± 4.5 days after admission in the severe group while it occurred in 30.5 ± 16.8 days in the moderate group (p = 0.024). The conditional inference tree and random forest revealed that severe IH might be considered as an index of visual deterioration. Visual field defect, fading eyesight, and papilledema were significantly worse in patients with severe IH as compared to patients with mild or moderate IH, all p < 0.01. CONCLUSIONS: IH ≥330 mmH2O may be a cut-off value to predict the deterioration of visual damage in CVST, revealing that ophthalmologic interventions should be considered in a timely manner in this condition, particularly when recanalization of cerebral venous sinus cannot be achieved within a short time.
BACKGROUND:Visual damage is one of the most common complications of cerebral venous sinus thrombosis (CVST)-associated intracranial hypertension (IH). This study is aimed at stratifying the risk of IH-induced visual damage in an attempt to predict its deterioration and prevent high-risk patients from irreversible eyesight impairment promptly. METHODS: A total of 94 patients with confirmed diagnosis of CVST were eligible for enrollment in this study. According to cerebrospinal fluid pressure at admission, the involved patients were classified into mild IH (< 250 mmH2O), moderate IH (250-330 mmH2O), and severe IH (≥330 mmH2O) groups. RESULTS: The ratio of visual deterioration in the severe IH group was 75%, which was significantly higher than in either the moderate (44.4%) or the mild groups (14.3%). As regards subjects without visual symptoms at admission, visual deterioration occurred in 9.4 ± 4.5 days after admission in the severe group while it occurred in 30.5 ± 16.8 days in the moderate group (p = 0.024). The conditional inference tree and random forest revealed that severe IH might be considered as an index of visual deterioration. Visual field defect, fading eyesight, and papilledema were significantly worse in patients with severe IH as compared to patients with mild or moderate IH, all p < 0.01. CONCLUSIONS: IH ≥330 mmH2O may be a cut-off value to predict the deterioration of visual damage in CVST, revealing that ophthalmologic interventions should be considered in a timely manner in this condition, particularly when recanalization of cerebral venous sinus cannot be achieved within a short time.
Authors: Christina Geisbüsch; Christian Herweh; Christoph Gumbinger; Peter A Ringleb; Markus A Möhlenbruch; Simon Nagel Journal: Neurol Res Pract Date: 2021-05-17