A Rare Case of Papilledema Due to Arteriovenous Fistula: A Masquerade with Dire Visual and Systemic Consequences

Title A Rare Case of Papilledema Due to Arteriovenous Fistula: A Masquerade with Dire Visual and Systemic Consequences
Author, Co-Author Jill Yuzuriha, Winnie Chao, Lee Vien, David Yang
Topic
Year
2015
Day
Thursday
Program Number
155163
Room
Great Hall Foyer
Affiliation
Abstract Background
Papilledema is swelling of the optic discs due to increased intracranial pressure. It may be caused by a variety of etiologies. One uncommon cause is arteriovenous (AV) fistula, which can be associated with life-threatening complications such as heart failure and stroke. A case is presented in which the earliest symptoms of AV fistula were visual, and the earliest signs included asymmetric optic disc edema.

Case Report
A 61-year-old Caucasian male presented as early as 2010 with transient blur OD. He was initially diagnosed with optic disc edema OD of unknown etiology. His visual fields showed peripheral constriction in all quadrants OD and moderate, mostly superior defects OS. Giant cell arteritis was ruled out and MRI/MRA, carotid ultrasound, and vascular risk factors were negative. Elevated intracranial pressure was deemed unlikely due to the patient’s brief, transient headaches and the initially unilateral nature of his optic disc edema with presence of spontaneous venous pulsation (SVP). A lumbar puncture was finally performed in April 2013 and showed elevated intracranial pressure. The patient was subsequently diagnosed with chronic dural venous sinus thrombosis and dural AV fistula. He underwent multiple AV fistula embolizations, a left occipital-parietal ventriculoperitoneal shunt, and an intratentorial and supratentorial craniotomy. He continues to display optic atrophy OD>OS with peripheral constriction of his visual fields in all quadrants resulting from his prior papilledema OD>OS. He requires careful monitoring due to continued visual symptoms.

Conclusions
The patient in this report likely had undiagnosed intracranial hypertension due to a longstanding AV fistula with atypical findings. It is rare that an AV fistula first presents with ocular signs and symptoms. However, it is important to consider ruling out such life-threatening conditions in a timely manner to maximize a patient’s visual functioning and quality of life.
Affiliation of Co-Authors VA Palo Alto Health Care System, VA Palo Alto Health Care System, VA Palo Alto Health Care System
Outline