Clinical Features, Management and Visual Outcomes of Children with Cerebral Venous Sinus Thrombosis, Raised Intra-Cranial Pressure and Papilloedema
Ryan Davies, MBBCH; Shoaib Hassan, MBBCH; Patrick Watts, MBBS
University Hospital of Wales
Cardiff, United Kingdom
Introduction: Intracranial hypertension (IIH) secondary to cerebral venous sinus thrombosis (CVST) in children is rare, with acute head and neck disorders being a leading cause. Resulting papilloedema can cause significant visual impairment if not treated adequately.
Methods: We performed a retrospective review of case notes for children under the age of 16 presenting to eye clinic in Cardiff with IIH and papilloedema secondary to CVST.
Results: Seven patients were identified. Four were male. Mean age was 6.4 years (4 to 10). All children had a preceding diagnosis of otitis media and mastoiditis with severe headaches. Diplopia was a presenting symptom in four children. Visual function was normal at presentation. The sigmoid sinus was involved in four cases, the transverse sinus in three and the sagittal sinus in one. Four patients were treated medically with acetazolomide and enoxaparin, three patients required surgery, including ventriculo-peritoneal shunts and optic nerve fenestration. Two children have been registered severely sight impaired with the remainder keeping good visual function. Esotropia and lateral rectus palsy resolved in all cases where present.
Discussion: CVST should be suspected in high risk children to avoid unnecessary delay in diagnosis. Optic nerve function needs to be monitored closely as blurred vision at presentation is rare.
Conclusion: Prompt management of IIH to preserve optic nerve function requires a close collaboration with neurology and neurosurgery. High risk children, such as those with mastoiditis and headaches should be screened regularly. Recovery of lateral rectus function can be a good indicator of disease resolution.
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