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Show Poster 13 Preretinal Hemorrhages In Intracranial Hypertension: A Case Series Megan Bill1, Devin Mackay1 1 Indiana University School of Medicine, Indianapolis, Indiana, USA Introduction: Preretinal hemorrhage with papilledema is associated with Terson's syndrome and intracranial hemorrhage but may also occur without intracranial hemorrhage. Data is limited regarding preretinal hemorrhage in the setting of intracranial hypertension (IH) without intracranial hemorrhage. We present three cases with varied causes of IH and preretinal hemorrhage. Description of Case(s): 1. 22 year-old woman with cerebral venous sinus thrombosis, right > left papilledema, and right eye sub-ILM hemorrhage. LP opening pressure was 25 cm of water. She had no history of excessive vomiting, coughing, or Valsalva. She was treated with rivaroxaban, acetazolamide, and right ONSF, and over the next year her visual acuity, papilledema, and sub-ILM hemorrhage improved. 2. 25 year-old man with idiopathic IH and right > left papilledema with right eye vitreous and optic disc hemorrhages. LP opening pressure was 28 cm of water. He was treated with topiramate with improvement of his papilledema and intraocular hemorrhages. 3. 53 year-old woman with new headaches and vision changes, bilateral mild papilledema with bilateral peripapillary hemorrhages and a subtle, linear preretinal hemorrhage in the right eye. Brain MRI revealed a large planum sphenoidale meningioma with edema of the frontal lobes, prechiasmatic optic nerves, optic chiasm and optic tracts. Her papilledema, retinal and preretinal hemorrhages improved following tumor resection. Conclusions, including unique features of the case(s): Despite papilledema with preretinal hemorrhage, with appropriate treatment no patient in the series suffered significant permanent visual loss. The variety of causes of IH with preretinal hemorrhage in this series without intracranial hemorrhage supports a proposed mechanism of increased intracranial pressure transmitted to the optic nerve sheath and retinal veins, causing potential venous stasis and capillary rupture. Preretinal hemorrhage was present in the eye with more severe papilledema when asymmetry was present. Further research is needed to determine the prognostic value of preretinal hemorrhage in the setting of IH. References: None. Keywords: High intracranial pressure/headache, Pupils retina, Tumors, Vascular disorders Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: ddmackay@iupui.edu 2020 Annual Meeting Syllabus | 71 |
