Neuro-ophthalmological features cerebral venous obstruction of

Abstract

Permit us to share with you r numerous subscribers a n d readers our experience on some features of cerebral venous obstruction (CVO) and idiopathic intracranial hypertension (IIH) (pseud otumour cerebrei) which can be used a s a differentiating feature. In the last 2 years, we have encountered four patients with superior sagittal sinus thrombosis (SSST), all of whom had severe photophobia in addition to the dramatic onset of headache , diplopia (esodeviation), a nd papiloedema . All the 4 patients were confirmed to have SSST by M RI a n d angiographic studies. None of these patients had pyramidal weakness in any limb or convulsive seizures. Three of them had diplopia (esodeviation ) due to abducen palsy. None of the patients with IIH, that we have seen so far, complained of photophobia , even though they had all other feature s of raised intracranial pressure as patients with SSST. SSST is a recognized cause of pseudotumor cerebri (1,2]. Purvin and collaborators alluded to three clinical profile s that are related to the mechanism of obstruction . The first of such profiles is sudden and sever e headache, diplopia (esodeviation), and marked papilloedema in patients suffering from intrinsic sagittal or lateral venous sinus thrombosis. Such dramatic presentation they concluded should allow differentiation from IIH. In view of our observation , we would like to add photophobia as a differentiation feature . This is an unusual presentation in IIH. We are not aware that photophobia has previously been observe d in patients suffering from cerebral sinus thrombosis.