Abstract Details

Title Utility of Magnetic Resonance or Computed Tomography Venography in the Evaluation of Overweight Women with Papilledema

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) S32 - Neuro-ophthalmology/Neuro-otology (4:06 PM-4:18 PM)

Poster/Presentation
Number 004

Objective To determine the utility of Magnetic Resonance Venography (MRV) or Computed Tomography Venography (CTV) in young, overweight women with incidentally discovered papilledema and patients presenting due to symptomatic intracranial hypertension (IC-HTN) with papilledema seen in neuro-ophthalmology.

Background MRV/CTV is routinely obtained to rule out dural venous sinus thrombosis (DVST) in patients with papilledema, but the urgency and necessity of these tests is still debated.

Design/Methods Retrospective study of consecutive female patients meeting inclusion criteria: i) age 16-50 years ii) papilledema iii) Optical coherence tomography (OCT)-Retinal Nerve Fibre Layer (RNFL) thickness >100mm iv) BMI >25kg/m² v) MRV/CTV head. Exclusion criteria: personal or family history of venous thrombosis, rheumatological disease, cancer or pregnancy. Patients were divided into Group-1 (incidentally discovered papilledema) and Group-2 [presented due to intracranial hypertension (IC-HTN) symptoms].

Results 103 patients (n=45 Group-1, n=58 Group-2) were included with a final diagnosis of idiopathic intracranial hypertension (IIH; n=94), drug-induced IC-HTN (n=4), DVST (n=2), intracranial mass (n=2) and POEMS (n=1). Group-2 patients were significantly more likely to have pulsatile tinnitus (p=0.017), TVOs (p=0.007) and showed a trend for increasing headache (p=0.058). Group-2 patients had a higher lumbar puncture opening pressure (38.5 vs. 33.0, p=0.013), but there was no difference in age, BMI, OCT-RNFL thickness or mean deviation between groups. MRV/CTV revealed distal transverse sinus stenosis in 100/104 (96%) of patients and DVST in 4 patients; however, 2 patients had a false positive result and the 2 patients with DVST had significant neurological symptoms.

Conclusions DVST is rare among overweight women with papilledema. No patient with incidentally discovered papilledema was ultimately diagnosed with DVST and MRV/CTV may be interpreted incorrectly and lead to false positive results. As such, there is room for clinical judgment when deciding to perform MRV/CTV in the workup in overweight women with incidentally discovered papilledema without risk factors.

Authors/Disclosures
Anna Kabanovski PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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