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Progressive optic neuropathy in idiopathic intracranial hypertension after optic nerve sheath fenestration.
J Neuroophthalmol. 2009 Dec; 29(4):281-3.JN

Abstract

A 16-year-old woman complaining of headache and declining vision in both eyes had papilledema, normal brain imaging, and a lumbar puncture showing a moderately high opening pressure (35 cm H2O) and normal cerebrospinal fluid constituents. For a diagnosis of idiopathic intracranial hypertension (IIH), she was treated with acetazolamide and methylprednisolone, but vision worsened, so she underwent bilateral optic sheath fenestration (ONSF). Within the 1st postoperative week, vision had improved and papilledema was less prominent. However, by the 14th postoperative day, vision had worsened and headache persisted. Lumbar puncture showed a very high opening pressure (65 cm H2O), so she underwent ventriculoperitoneal shunting. Although there was a slight initial improvement in vision, it eventually declined further. This case emphasizes that ONSF may yield initial improvement in vision and reduction in papilledema yet not prevent eventual visual loss in IIH. Whether the visual loss in this patient resulted from persistently elevated intracranial pressure after ONSF or was prefigured before ONSF occurred is unresolved. It is a reminder that patients with IIH must be monitored carefully after ONSF. If there is a suggestion of further visual loss, shunting should be considered if intracranial pressure is high.

Authors+Show Affiliations

Dean McGee Eye Institute, Department of Ophthalmology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19952899

Citation

Wilkes, Byron N., and R Michael Siatkowski. "Progressive Optic Neuropathy in Idiopathic Intracranial Hypertension After Optic Nerve Sheath Fenestration." Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, vol. 29, no. 4, 2009, pp. 281-3.
Wilkes BN, Siatkowski RM. Progressive optic neuropathy in idiopathic intracranial hypertension after optic nerve sheath fenestration. J Neuroophthalmol. 2009;29(4):281-3.
Wilkes, B. N., & Siatkowski, R. M. (2009). Progressive optic neuropathy in idiopathic intracranial hypertension after optic nerve sheath fenestration. Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, 29(4), 281-3. https://doi.org/10.1097/WNO.0b013e3181c2530b
Wilkes BN, Siatkowski RM. Progressive Optic Neuropathy in Idiopathic Intracranial Hypertension After Optic Nerve Sheath Fenestration. J Neuroophthalmol. 2009;29(4):281-3. PubMed PMID: 19952899.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Progressive optic neuropathy in idiopathic intracranial hypertension after optic nerve sheath fenestration. AU - Wilkes,Byron N, AU - Siatkowski,R Michael, PY - 2009/12/3/entrez PY - 2009/12/3/pubmed PY - 2010/2/3/medline SP - 281 EP - 3 JF - Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society JO - J Neuroophthalmol VL - 29 IS - 4 N2 - A 16-year-old woman complaining of headache and declining vision in both eyes had papilledema, normal brain imaging, and a lumbar puncture showing a moderately high opening pressure (35 cm H2O) and normal cerebrospinal fluid constituents. For a diagnosis of idiopathic intracranial hypertension (IIH), she was treated with acetazolamide and methylprednisolone, but vision worsened, so she underwent bilateral optic sheath fenestration (ONSF). Within the 1st postoperative week, vision had improved and papilledema was less prominent. However, by the 14th postoperative day, vision had worsened and headache persisted. Lumbar puncture showed a very high opening pressure (65 cm H2O), so she underwent ventriculoperitoneal shunting. Although there was a slight initial improvement in vision, it eventually declined further. This case emphasizes that ONSF may yield initial improvement in vision and reduction in papilledema yet not prevent eventual visual loss in IIH. Whether the visual loss in this patient resulted from persistently elevated intracranial pressure after ONSF or was prefigured before ONSF occurred is unresolved. It is a reminder that patients with IIH must be monitored carefully after ONSF. If there is a suggestion of further visual loss, shunting should be considered if intracranial pressure is high. SN - 1536-5166 UR - https://www.unboundmedicine.com/medline/citation/19952899/Progressive_optic_neuropathy_in_idiopathic_intracranial_hypertension_after_optic_nerve_sheath_fenestration_ L2 - https://doi.org/10.1097/WNO.0b013e3181c2530b DB - PRIME DP - Unbound Medicine ER -