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Long-term progressive deterioration of visual function after papilledema improved by embolization of a dural arteriovenous fistula in the sigmoid sinus: a case report.

Zako M, Murata K, Inukai T, Yasuda M, Iwaki M - J Med Case Rep (2014)

Bottom Line: Nevertheless, his best-corrected visual acuity gradually deteriorated over the following three months.Angiography demonstrated a dural arteriovenous fistula in his sigmoid sinus.However, over the subsequent four years, his best-corrected visual acuity progressively deteriorated due to an unknown cause, despite the successful embolization of the dural arteriovenous fistula.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan. zako@aichi-med-u.ac.jp.

ABSTRACT

Introduction: It is generally believed that people affected by papilledema will not have progressive damage to their eyesight if they receive adequate medical care to treat the underlying cause of the papilledema. We present a case that appears to contradict this widely accepted belief.

Case presentation: A 53-year-old Japanese man with tinnitus visited our hospital. His initial best-corrected visual acuity in either eye was not impaired, although they both exhibited papilledema. Magnetic resonance imaging did not reveal a mass or hemorrhagic lesion in our patient's brain. Nevertheless, his best-corrected visual acuity gradually deteriorated over the following three months. Angiography demonstrated a dural arteriovenous fistula in his sigmoid sinus. After embolization therapy, the papilledema improved in both eyes. However, over the subsequent four years, his best-corrected visual acuity progressively deteriorated due to an unknown cause, despite the successful embolization of the dural arteriovenous fistula.

Conclusion: There may be delayed onset of an unknown pathophysiology in the visual system after treatment for the underlying cause of papilledema, implying an uncertain visual prognosis for patients with this condition.

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Related in: MedlinePlus

Photographs showing optic discs before and after treatment. (a) Optic disc on the first visit. (b) Optic disc three months after transarterial and transvenous embolization therapy. (c) Optic disc four years after embolization therapy.
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Fig1: Photographs showing optic discs before and after treatment. (a) Optic disc on the first visit. (b) Optic disc three months after transarterial and transvenous embolization therapy. (c) Optic disc four years after embolization therapy.

Mentions: A 53-year-old Japanese man presented to our hospital complaining of tinnitus over a period of three weeks. He also noted slightly abnormal “fuzzy” vision in the previous two weeks. An otorhinologist was consulted to rule out Vogt–Koyanagi–Harada disease.An ocular evaluation revealed a best-corrected visual acuity (BCVA) of 1.2 in his right eye and 1.0 in his left eye. His intraocular pressure was 14mmHg in his right eye and 16mmHg in his left eye. The anterior segment was normal in both eyes. However, a fundus evaluation revealed a significant papilledema in each eye (Figure 1).Figure 1


Long-term progressive deterioration of visual function after papilledema improved by embolization of a dural arteriovenous fistula in the sigmoid sinus: a case report.

Zako M, Murata K, Inukai T, Yasuda M, Iwaki M - J Med Case Rep (2014)

Photographs showing optic discs before and after treatment. (a) Optic disc on the first visit. (b) Optic disc three months after transarterial and transvenous embolization therapy. (c) Optic disc four years after embolization therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289324&req=5

Fig1: Photographs showing optic discs before and after treatment. (a) Optic disc on the first visit. (b) Optic disc three months after transarterial and transvenous embolization therapy. (c) Optic disc four years after embolization therapy.
Mentions: A 53-year-old Japanese man presented to our hospital complaining of tinnitus over a period of three weeks. He also noted slightly abnormal “fuzzy” vision in the previous two weeks. An otorhinologist was consulted to rule out Vogt–Koyanagi–Harada disease.An ocular evaluation revealed a best-corrected visual acuity (BCVA) of 1.2 in his right eye and 1.0 in his left eye. His intraocular pressure was 14mmHg in his right eye and 16mmHg in his left eye. The anterior segment was normal in both eyes. However, a fundus evaluation revealed a significant papilledema in each eye (Figure 1).Figure 1

Bottom Line: Nevertheless, his best-corrected visual acuity gradually deteriorated over the following three months.Angiography demonstrated a dural arteriovenous fistula in his sigmoid sinus.However, over the subsequent four years, his best-corrected visual acuity progressively deteriorated due to an unknown cause, despite the successful embolization of the dural arteriovenous fistula.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan. zako@aichi-med-u.ac.jp.

ABSTRACT

Introduction: It is generally believed that people affected by papilledema will not have progressive damage to their eyesight if they receive adequate medical care to treat the underlying cause of the papilledema. We present a case that appears to contradict this widely accepted belief.

Case presentation: A 53-year-old Japanese man with tinnitus visited our hospital. His initial best-corrected visual acuity in either eye was not impaired, although they both exhibited papilledema. Magnetic resonance imaging did not reveal a mass or hemorrhagic lesion in our patient's brain. Nevertheless, his best-corrected visual acuity gradually deteriorated over the following three months. Angiography demonstrated a dural arteriovenous fistula in his sigmoid sinus. After embolization therapy, the papilledema improved in both eyes. However, over the subsequent four years, his best-corrected visual acuity progressively deteriorated due to an unknown cause, despite the successful embolization of the dural arteriovenous fistula.

Conclusion: There may be delayed onset of an unknown pathophysiology in the visual system after treatment for the underlying cause of papilledema, implying an uncertain visual prognosis for patients with this condition.

Show MeSH
Related in: MedlinePlus