Indian Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2011  |  Volume : 59  |  Issue : 4  |  Page : 337--338

Comments on: Clinical profile of cerebral venous sinus thrombosis and role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension


Shikha Bassi 
 Department of Neuro-Ophthalmology, Sankara Nethralaya, 18 College Road, Nungambakkam, Chennai - 600 006, India

Correspondence Address:
Shikha Bassi
Department of Neuro-Ophthalmology, Sankara Nethralaya, 18 College Road, Nungambakkam, Chennai-600 006
India




How to cite this article:
Bassi S. Comments on: Clinical profile of cerebral venous sinus thrombosis and role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension.Indian J Ophthalmol 2011;59:337-338


How to cite this URL:
Bassi S. Comments on: Clinical profile of cerebral venous sinus thrombosis and role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension. Indian J Ophthalmol [serial online] 2011 [cited 2019 Nov 13 ];59:337-338
Available from: http://www.ijo.in/text.asp?2011/59/4/337/82020


Full Text

Dear Editor,

I read with interest the article titled "The clinical profile of cerebral venous sinus thrombosis (CVST) and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension (IIH)" by Agarwal et al. [1] I appreciate the point made about the need for magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in all the patients with IIH, but there are a few issues which need clarifications and could be discussed further.

Firstly, how many of the included patients underwent computed tomography (CT)/MRI/MRV is not very clear. The second paragraph states that the patients were excluded if they had space-occupying lesion (SOL), hydrocephalus, etc and "the remaining patients underwent MRI and MRV", but the number of patients who underwent these investigations is not mentioned.

As the aim of the study was to report the rate of occurrence of CVST in patients with presumed IIH, it is important to clearly indicate the number of patients included in the study after excluding the patients according to the mentioned exclusion criteria. I infer from the given data that there were 308 patients included in the study and all 308 patients had undergone a baseline CT brain which was normal and a lumbar puncture which revealed a cerebrospinal fluid opening pressure of more than 200 mm of water. I would like to know whether the author is implying the same.

Another study giving the incidence of CVST in patients with papilledema in the absence of SOL and with normal ventricles is by Kesler et al. [2] who mention that seven out of 141 patients with pseudotumor cerebri had associated sinus venous thrombosis. The authors have compared their results with those of Lee et al. [3] which have a totally different study population. As mentioned by the authors, Lee et al. have studied the role of MRV in 22 females of age less than 50 years. Their study questions the role of MRV in females with a typical demographic profile of IIH. Since the authors' series had nine females of which at least six were in the child-bearing age group the study shows that the CT /MRI could miss the diagnosis of CVST even in females with a typical demographic profile of IIH.

Lastly, in the discussion the authors state that "CVST is typically treated with anticoagulants and IIH with diuretics." CVST patients also require diuretics (anti-edema treatment) along with the anticoagulants.

References

1Agarwal P, Kumar M, Arora V. Clinical profile of cerebral venous sinus thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension. Indian J Ophthalmol 2010;58:153-5.
2Kesler A, Goldhammer Y, Gadoth N. Do men with pseudomotor cerebri share the same characteristics as women? A retrospective review of 141 cases. J Neuroophthalmol 2001;21:15-7.
3Lee AG, Brazis PW. Magnetic resonance venography in idiopathic pseudotumor cerebri. J Neuroophthalmol 2000;20:12-3.