Browsing by Subject "papilledema"

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    Central Venous Obstruction–Induced Intracranial Hypertension in Hemodialysis Patients: An Underrecognized Cause of Elevated Intracranial Pressure
    (Wolters Kluwer, 2020-06) Mackay, Devin D.; Takacs, Sara M.; Neurology, School of Medicine
    Background: Central venous obstruction (stenosis or occlusion) is common in patients with renal failure on hemodialysis and may be associated with intracranial hypertension (IH). Causes include vein injury from an endoluminal device, lumen obstruction from a device or thrombus, external vein compression, and high venous flow leading to vein intimal hyperplasia. A combination of high venous flow and central venous obstruction can lead to intracranial venous hypertension, impaired cerebrospinal fluid (CSF) resorption, and subsequent IH. Evidence Acquisition: We conducted a search of the English literature using the Ovid MEDLINE Database and PubMed, with a focus on reports involving IH and central venous obstruction in the setting of hemodialysis. We reviewed CSF flow dynamics, the risk factors and causes of central venous obstruction, and the evaluation, management, and outcomes of central venous obstruction-induced IH. Results: Twenty-four cases of IH related to central venous obstruction in hemodialysis patients were identified. Twenty patients had headaches (83.3%) and 9 had visual symptoms (37.5%). The brachiocephalic vein was the most common site of stenosis or occlusion (20/24, 83.3%). Twenty-one patients (87.5%) had resolution of IH with treatment. Two patients died from complications of IH (8.3%). Conclusions: Central venous obstruction–induced IH is likely underrecognized by clinicians and mimics idiopathic IH. Hemodialysis patients with IH should be screened with computed tomography venography of the chest. Optimal treatment is with vascular intervention or a CSF diversion procedure and can help prevent vision loss from papilledema or nervous system damage. Medical management may be appropriate in mild cases or as a bridge to definitive interventional treatment. Increased awareness among clinicians has potential to facilitate the timely diagnosis of this treatable condition with potential for good neurologic and visual outcomes.
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    The Effects of Hydrocephalus on the Retina and the Optic Nerve
    (2023-12) Loftin, Michelle; Belecky-Adams, Teri; Blazer-Yost, Bonnie; Jantzie, Lauren
    Papilledema is the swelling of the optic disc resulting from increased cranial pressure (ICP). A diagnosis of papilledema is important to not only treat pathologies of the eye, but it also can be an important indicator of underlying brain pathology since the subarachnoid space surrounding the optic nerve is contiguous with the brain. Therefore, the increased cranial pressure from brain pathology can be transmitted to the eye. Thus, it is important to have further understanding of the mechanism of papilledema and the anatomical and cellular changes that occur with sustained ICP. To study papilledema, a reproducible post hemorrhagic hydrocephalic (PHH) rat model was used to study the changes of the retina, optic disc, and optic nerve when exposed to high levels of ICP. Multiple retinal changes were noted in the PHH rats including decreased retinal thickness in the peripheral retina in female rats and increased retinal thickness close to the optic disc in male rats. PHH caused a decrease in ganglion cell layer thickness in the peripheral retina. In addition, vascular changes were noted with the PHH rats having an increased occurrence of enlarged retinal vasculature. In addition, the PHH rats had an increased optic disc width from analyzed retinal sections and increased optic disc diameter on optical coherence tomography (OCT). Also, PHH caused a decrease in retinal ganglion cells (RGC). These experiments confirm that PHH model in rats can produce retinal and optic disc phenotypes that are similar to those found in human pathology. Therefore, future studies are indicated utilizing the PHH rat model to provide further understanding of the mechanism of papilledema progression and to allow for the study of possible therapeutics.