Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 3023
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 2  |  Page : 169

Clinical profile of cerebral venous thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension


1 Department of Ophthalmology, St John's Medical College, Sarjapur Road, Bangalore - 560 034, India
2 Department of Neurology, St John's Medical College, Sarjapur Road, Bangalore - 560 034, India

Date of Web Publication23-Feb-2011

Correspondence Address:
Suneetha Nithyanandam
Department of Ophthalmology, St John's Medical College Hospital, Sarjapur Road, Bangalore - 560 034
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.77025

Rights and Permissions

How to cite this article:
Nithyanandam S, Joseph M, Mathew T. Clinical profile of cerebral venous thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension. Indian J Ophthalmol 2011;59:169

How to cite this URL:
Nithyanandam S, Joseph M, Mathew T. Clinical profile of cerebral venous thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension. Indian J Ophthalmol [serial online] 2011 [cited 2020 Jun 7];59:169. Available from: http://www.ijo.in/text.asp?2011/59/2/169/77025

Dear Editor,

We read with interest the article on cerebral venous thrombosis (CVT) and idiopathic intracranial hypertension (IIH) by Agarwal et al., and wish to make the following comments. [1]

About 40% of all cases of CVT present with a syndrome of isolated intracranial hypertension (IICH), while the remaining 60% present with encephalopathy and focal deficits; in the antibiotic era the fourth rather uncommon presentation is cavernous sinus thrombosis. [2],[3] The syndrome of IICH due to CVT mimics IIH closely. To differentiate these two conditions (CVT from IIH) Friedman has modified Dandy's criteria. [4] The modification includes the necessity for magnetic resonance imaging (MRI) of the brain to rule out CVT in typical patients of IIH and gadolinium-enhanced magnetic resonance venography (MRV) in atypical IIH patients, like children and young adult males. [4]

At our center which is a multispecialty tertiary care private medical college hospital we have routinely been using MRI with and without MRV since 2000 in all cases of IIH. We found 30/82 (36.5%) patients with IIH-like clinical picture to have CVT, in contrast to 11% reported in this study, by Agarwal et al. This lesser diagnosis of CVT in IIH patients may be due to non-use of MRI routinely. In fact MRI is the standard of care in all brain syndromes, with computed tomography (CT) being done only in the presence of severe cost constraints. In fact it is economical to consider MRI as the primary imaging modality, as equivocal findings on CT would warrant additional MRI and cost to the patient.

As the report by Agarwal et al., is from a tertiary care ophthalmic institute the patients would have primarily been referred from a neurology unit for ocular complaints. It would have been interesting to know the occurrence of visual loss and ocular manifestations in the cohort presented. Severe visual loss is often the primary presentation of both CVT and IIH. [5] At our institute we are in the process of evaluating the occurrence of visual loss and visual outcome in CVT patients. In our patients we have documented visual field loss of varying severity in 31/60 (52.5%) patients with CVT; while the occurrence of visual loss in IIH patients in the same time period was 12/52 (23.1%). The visual loss in CVT is more acute and less amenable to treatment than visual loss in IIH. [5] Nevertheless all patients with CVT require regular monitoring of visual function, both central acuity and visual field analysis to prevent/reduce irreversible visual loss.

 
  References Top

1.
Agarwal P, Kumar M, Arora V. Clinical profile of cerebral venous thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension. Indian J Ophthalmol 2010;58:153-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Crassard I, Bousser MG. Cerebral Venous Thrombosis. J Neuroophthalmol 2004;24:156- 63.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Biousse V, Ameri A, Bousser MG. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology 2000;54:2030-6.  Back to cited text no. 3
    
4.
Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension J Neuroophthalmol 2004;24:138-45.  Back to cited text no. 4
    
5.
Nithyanandam S, Manayath GJ, BattuRR. Optic nerve sheath decompression for visual loss in intracranial hypertension: Report from a tertiary care center in South India. Indian J Ophthalmol 2008;56:115-20.  Back to cited text no. 5
[PUBMED]  Medknow Journal  



This article has been cited by
1 Design, Synthesis, andIn VitroAntiplatelet Aggregation Activities of Ferulic Acid Derivatives
Peng-Xuan Zhang,Hang Lin,Cheng Qu,Yu-Ping Tang,Nian-Guang Li,Jun Kai,Guanxiong Shang,Baoquan Li,Li Zhang,Hui Yan,Pei Liu,Jin-Ao Duan
Journal of Chemistry. 2015; 2015: 1
[Pubmed] | [DOI]
2 Neuro-ophthalmological Features of Cerebral Venous Sinus Thrombosis
N. Eliseeva,N. Serova,S. Yakovlev,K. Mikeladze,Y. Arkhangelskaya,S. Gasparyan
Neuro-Ophthalmology. 2014; : 1
[Pubmed] | [DOI]
3 Authorsę reply
Agarwal, P., Kumar, M., Arora, V.
Indian Journal of Ophthalmology. 2011; 59(2): 169-170
[Pubmed]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed1090    
    Printed29    
    Emailed0    
    PDF Downloaded163    
    Comments [Add]    
    Cited by others 3    

Recommend this journal