Although magnetic resonance venography (MRV) and computed tomography (CT) venography can rule out dural venous sinus thrombosis (a type of cerebral thrombosis) in patients with papilledema, many debate these tests’ value in young, obese female patients who fit a typical idiopathic intracranial hypertension (HTN) presentation. A recent study determined that dural venous sinus thrombosis is rare among overweight women with papilledema and without any other risk factors. Given the low risk for secondary causes of intracranial HTN in this group, patients with incidentally-found papilledema who already underwent CT/MRI without venography can likely be observed clinically without the need for additional venous testing, researchers suggest.

The study included 103 overweight female patients between the ages of 16 and 50 who were divided into two groups: those with incidentally-discovered papilledema (Group 1; n=45) and those who presented due to symptoms of intracranial HTN (Group 2; n=58).

None of the patients in Group 1 were ultimately diagnosed with dural venous sinus thrombosis, and false positive results were more common in this patient group. The only two patients who were diagnosed with the cerebral thrombosis (1.9%) were in Group 2 and presented with significant neurological symptoms. Group 2 patients were more likely to have pulsatile tinnitus, transient visual obscurations and more severe headache. Group 2 was also more likely to have been treated with acetazolamide and undergo lumbar puncture.

The investigators concluded that it is reasonable practice to perform MRI alone, without dedicated MRV or CT venography, in the investigation of young, overweight women with incidentally-discovered papilledema and without risk factors for cerebral thrombosis. “These patients rarely harbor sinister causes of increased intracranial pressure,” they concluded in their paper.

Kabanovski A, Wong JCY, Margolin EA, et al. Magnetic resonance or computed tomography venography in the evaluation of young overweight women with papilledema. Eye (Lond). October 26, 2020. [Epub ahead of print].