A RARE CASE OF SPONTANEOUS SUB-RETINAL HAEMORRHAGE ASSOCIATED WITH IDOPATHIC INTRACRANIAL HYPERTENSION
Article Sidebar
Main Article Content
http://orcid.org/0000-0002-8492-1733
Abstract
Introduction: Idiopathic Intracranial Hypertension (IIH)is defined as increase in intracranial pressure due to unspecified causes leading to headache, papilledema, and transient vision loss. Usually the patients present with mild visual loss but about 25% may develop permanent visual loss due to irreversible optic disc damage. One rare cause of severe visual loss is subretinal hemorrhage (SRH) due to underlying Subretinal Neovascular membrane.
Case Report: We report a case of a 36-year-old man diagnosed with IIH and papilloedema with sudden onset profound visual loss in his right eye. On examination, there was a large peripapillary SRH superior to the disc and involving the macula.We stress the importance of recognizing this uncommon complication of papilledema and discuss the possible causes for developing SRH, its most common outcome and the diagnostic as well as treatment modalities available.
Discussion: We stress the importance of recognizing this uncommon complication of papilledema and discuss the possible causes for developing SRH, its most common outcome and the diagnostic as well as current treatment modalities available.
Conclusion: This report highlights a rare case of spontaneous sub retinal haemorrhage in a patient with IIH. Measurement of optic nerve sheath diameter can be a vital tool for the diagnosis of raised intracranial pressure in this setting.
Keywords
Papilledema, Idiopathic intracranial hypertension, Sub retinal haemorrhage, spontaneous sub- retinal haemorrhage
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
(2) Sathornsumetee B, Webb A, Hill DL, Newman NJ, Biousse V. Subretinal hemorrhage from a peripapillary choroidal neovascular membrane in papilledema caused by idiopathic intracranial hypertension. Journal of neuro-ophthalmology. 2006;26:197-9.
(3) Bø SH, Lundqvist C. Cerebrospinal fluid opening pressure in clinical practice–a prospective study. Journal of Neurology. 2020;267:3696-701.
(4) Jamison RR. Subretinal neovascularization and papilledema associated with pseudotumor cerebri. American journal of ophthalmology. 1978;85:78-81.
(5) Troost BT, Sufit RL, Grand MG. Sudden monocular visual loss in pseudotumor cerebri. Archives of Neurology. 1979;36:440-2.
(6) Morris AT, Sanders MD. Macular changes resulting from papilloedema. British Journal of Ophthalmology. 1980;64:211-6.
(7) Morse PH, Leveille AS, Antel JP, et al. Bilateral juxtapapillary subretinal neovascularization associated with pseudotumor cerebri. Am J Ophthalmol 1981;91:312–7.
(8) Castellarin AA, Sugino IK, Nasir M, et al. Clinicopathological correlation of an excised choroidal neovascular membrane in pseudotumor cerebri. Br J Ophthalmol 1997;81:994–1000.
(9) Akova YA, Kansu T, Yazar Z, et al. Macular subretinal neovascular membrane associated with pseudotumor cerebri. J Neuroophthalmol 1994;14:193–5.
(10) Wendel L, Lee AG, Boldt HC, Kardon RH, Wall M. Subretinal neovascular membrane in idiopathic intracranial hypertension. American journal of ophthalmology. 2006;141:573-4.
(11) Dvorak HF, Brown LF, Detmar M, Dvorak AM. Vascular permeability factor/vascular endothelial growth factor, microvascular hyperpermeability, and angiogenesis. The American journal of pathology. 1995;146:1029.
(12) El Baba F, Jarrett II WH, Harbin Jr TS, Fine SL, Michels RG, Schachat AP, Green WR. Massive hemorrhage complicating age-related macular degeneration: clinicopathologic correlation and role of anticoagulants. Ophthalmology. 1986 ;93:1581-92.
(13) Wei Y, Zhang Z, Jiang X, Li F, Zhang T, Qiu S, Yang Y, Zhang S. A surgical approach to large subretinal hemorrhage using pars plana vitrectomy and 360 retinotomy. Retina. 2015;35:1631-9.
(14) Fleissig E, Barak A, Goldstein M, Loewenstein A, Schwartz S. Massive subretinal and subretinal pigment epithelial hemorrhage displacement with perfluorocarbon liquid using a two-step vitrectomy technique. Graefe's Archive for Clinical and Experimental Ophthalmology. 2017 ;255:1341-7.
(15) Shirodkar CG, Rao SM, Mutkule DP, Harde YR, Venkategowda PM, Mahesh MU. Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2014;18:728.