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Papilledema secondary to internal jugular veins thrombosis in a peritoneal dialysis patient
Author(s) -
Braga J.,
Loureiro M.,
Barros P.,
Gomes A.M.,
Meira D.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0305
Subject(s) - medicine , papilledema , internal jugular vein , thrombosis , lumbar puncture , peritoneal dialysis , surgery , blurred vision , venography , hemodialysis , radiology , arteriovenous fistula , pseudotumor cerebri , end stage renal disease , fundus (uterus) , cerebrospinal fluid , intracranial pressure
Purpose Intracranial hypertension secondary to internal jugular vein (IJV) thrombosis has been described in patients undergoing hemodialysis with peripheral hemodialysis shunts or repeated subclavian and jugular veins catheterizations. Pseudotumor cerebri, with no identified IJV thrombosis has also been reported in dialysis patients and has been associated with chronic or recurrent dialysis disequilibrium. We aim to report the case of a dialysis patient with papilledema secondary to bilateral IJV thrombosis. Methods Case report with fundus photography, optical coherence tomography, perimetry, brain imaging with venography, cerebrospinal fluid (CSF) analysis and neck eco Doppler. Results A 38‐year‐old man with end stage kidney disease undergoing peritoneal dialysis for 4 years presented with transient blurred vision, lasting a few minutes at a time, exacerbated by positional changes, with no vision loss or other symptoms. Physical examination revealed bilateral disc edema. No other ophthalmologic or neurological signs were found. Head CT with venography was unremarkable. Lumbar puncture CSF opening pressure was 23 cm H 2 O with normal CSF composition. Humphrey visual field were normal. Posterior neck eco Doppler showed absence of IJV bilaterally, which established the diagnosis. Conclusions Papilledema secondary to IJV thrombosis may occur in dialysis patients as a result of hemodynamic factors related to arteriovenous fistulas or chest/neck veins catheterization and also in patients undergoing peritoneal dialysis. End stage kidney disease is associated with higher risk of cardiovascular events and IJV thrombosis must be promptly ruled out in patients presenting with altered vision and papilledema.