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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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Goldmann kinetic visual field, obtained before and after transarterial and transvenous embolization therapy.
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Fig5: Goldmann kinetic visual field, obtained before and after transarterial and transvenous embolization therapy.

Mentions: Ten weeks after his first visit to our hospital, our patient began to experience sporadic marked blurred vision and transient day blindness. His BCVA had deteriorated moderately to 0.9 in his right eye and 0.8 in his left eye. A neurosurgeon detected a DAVF in his sigmoid sinus on angiography. The fistula was classified as type I, according to Borden classification, and type IIa, according to Cognard classification.Transarterial and transvenous embolization was successfully performed to treat the causative DAVF. Three weeks after therapy, the papilledema had significantly improved (Figure 1) but the BCVA in our patient’s right and left eyes was 0.8 and 0.3, respectively. His tinnitus disappeared by one week after embolization therapy. The angiography results before and after embolization are presented in Figure 2.We followed this patient for four years. Regular ocular examinations demonstrated the absence of papilledema recurrence. However, the patient’s BCVA continued to deteriorate progressively (Figure 3), with concurrent complete disc paling (Figure 1) but without thinning of the foveal retina or retina around the disc, as determined by optical coherence tomography (OCT) (Figure 4).A mild vitreomacular adhesion in his right eye was revealed by OCT with SDOCT RS-3000 (Nidek Co., Ltd, Aichi, Japan) and Nidek Advanced Vision Information System EX version 1.3.0.3 (Nidek Co., Ltd) (Figure 4). Our patient did not notice metamorphopsia, and he did not request pars plana vitrectomy. Goldmann perimetry showed progressive narrowing of the visual field in both eyes after embolization (Figure 5).Figure 2


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)

Goldmann kinetic visual field, obtained before and after transarterial and transvenous embolization therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: Goldmann kinetic visual field, obtained before and after transarterial and transvenous embolization therapy.
Mentions: Ten weeks after his first visit to our hospital, our patient began to experience sporadic marked blurred vision and transient day blindness. His BCVA had deteriorated moderately to 0.9 in his right eye and 0.8 in his left eye. A neurosurgeon detected a DAVF in his sigmoid sinus on angiography. The fistula was classified as type I, according to Borden classification, and type IIa, according to Cognard classification.Transarterial and transvenous embolization was successfully performed to treat the causative DAVF. Three weeks after therapy, the papilledema had significantly improved (Figure 1) but the BCVA in our patient’s right and left eyes was 0.8 and 0.3, respectively. His tinnitus disappeared by one week after embolization therapy. The angiography results before and after embolization are presented in Figure 2.We followed this patient for four years. Regular ocular examinations demonstrated the absence of papilledema recurrence. However, the patient’s BCVA continued to deteriorate progressively (Figure 3), with concurrent complete disc paling (Figure 1) but without thinning of the foveal retina or retina around the disc, as determined by optical coherence tomography (OCT) (Figure 4).A mild vitreomacular adhesion in his right eye was revealed by OCT with SDOCT RS-3000 (Nidek Co., Ltd, Aichi, Japan) and Nidek Advanced Vision Information System EX version 1.3.0.3 (Nidek Co., Ltd) (Figure 4). Our patient did not notice metamorphopsia, and he did not request pars plana vitrectomy. Goldmann perimetry showed progressive narrowing of the visual field in both eyes after embolization (Figure 5).Figure 2

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