Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
Papilledema and related clinical and paraclinical visual assessment in cerebral venous and sinus thrombosis versus idiopathic intracranial hypertension.
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Martins Ana Inês, Jorge André, Matos Sara, Damas Diogo, Silva Liliana, Pais Inês, Silva Beatriz, Fonseca Pedro, Sousa João, Silva Fernando, Nunes César, Castelo-Branco Miguel, Sargento-Freitas João, Lemos João
Аннотация
INTRODUCTION: Cerebral venous and sinus thrombosis (CVST) is a life-threatening disorder which can present with papilledema. Idiopathic intracranial hypertension (IIH) also presents with papilledema, but is a relatively benign condition. Despite often presenting in a similar manner, CVST and IIH may lead to markedly different outcomes. We investigated if papilledema severity, related clinical features, and paraclinical visual assessment, can be used to differentiate between CVST and IIH-related papilledema, this way trying to improve a priori probability for both conditions at the bedside.
METHODS: Consecutive CVST and IIH ambulant alert patients presenting with papilledema were enrolled. Clinical and paraclinical (optical coherence tomography, automated perimetry) data were compared between groups.
RESULTS: Twelve out of 39 CVST and 34 IIH patients were recruited (males: 2 [CVT], 8 [IIH]; mean age: 40,8 [CVST], 34,1 years [IIH] [p = 0,249]). CVST patients presented with lower papilledema Frisén grade (p = 0.036 OD, p = 0.013 OS), more headache (p = 0.017), shorter headache duration (p = 0.000), and less scotomas on the Amsler grid (p = 0.047). Diplopia was only present in IIH group (n = 7) and additional focal neurological signs were only present in CVST group (n = 5). The CVST group further showed lower peripapillary retinal nerve fiber layer (RNFL) thickness (p = 0.03 OD, p = 0.04 OS), and near significantly lower perimetric mean deviation ((p = 0,058 OD, 0,06 OS). Time to observation, RNFL thickness, and Frisén grade showed area under curve values > 0.76 for distinguishing CVST versus IIH. (0.904, 0.822, 0.761, respectively) CONCLUSIONS: Combined clinical and paraclinical visual assessment can help to distinguish between CVST- vs. IIH-related papilledema at the bedside.
METHODS: Consecutive CVST and IIH ambulant alert patients presenting with papilledema were enrolled. Clinical and paraclinical (optical coherence tomography, automated perimetry) data were compared between groups.
RESULTS: Twelve out of 39 CVST and 34 IIH patients were recruited (males: 2 [CVT], 8 [IIH]; mean age: 40,8 [CVST], 34,1 years [IIH] [p = 0,249]). CVST patients presented with lower papilledema Frisén grade (p = 0.036 OD, p = 0.013 OS), more headache (p = 0.017), shorter headache duration (p = 0.000), and less scotomas on the Amsler grid (p = 0.047). Diplopia was only present in IIH group (n = 7) and additional focal neurological signs were only present in CVST group (n = 5). The CVST group further showed lower peripapillary retinal nerve fiber layer (RNFL) thickness (p = 0.03 OD, p = 0.04 OS), and near significantly lower perimetric mean deviation ((p = 0,058 OD, 0,06 OS). Time to observation, RNFL thickness, and Frisén grade showed area under curve values > 0.76 for distinguishing CVST versus IIH. (0.904, 0.822, 0.761, respectively) CONCLUSIONS: Combined clinical and paraclinical visual assessment can help to distinguish between CVST- vs. IIH-related papilledema at the bedside.