An Unusual Case of Papilledema

Introduction: Papilledema can result from anything increasing intracranial pressure. This is most common with local mass effect, but it also can be due to pathology affecting CSF outflow. It can occur either at absorption, pacchionian granulations (IIH, meningitis), or with impairment of the draining sinuses including the sagittal sinus, the transverse sinus, or sigmoid sinus. The most common tumor to affect the sagittal sinus is a meningioma, but other lesions are possible.

Material and Methods: A single case report of a 77-year-old gentleman referred for light sensitivity noted to have a bump on his occiput. Evaluation revealed evidence of severe bilateral disc edema with moderately preserved central acuity, but severe arcuate visual field defects and evidence of OCT abnormalities.

Results: Review of his MRI scan revealed a very large occipital lesion obstructing the sagittal sinus which on biopsy showed clear cell tumor. He was treated with shunt placement and fractionated radiation therapy with dramatic improvement in optic nerve function, although leaving evidence of residual damage.

Conclusion: Static lesions are a potential cause of venous outflow obstruction leading to papilledema and secondary optic nerve pathology. Psychophysical abnormalities (including vision and visual fields) can be reversed with procedures to lower intracranial pressure including shunting procedure, resulting in substantial improvement in afferent system function. OCT may be very helpful in documenting anatomic changes in the visual system.