Cerebral venous hypertension and blindness: a reversible complication.
A 57-year-old woman developed blindness during treatment for sarcoidosis-induced end-stage renal disease. An initial renal transplantation failed, and hemoaccess was maintained with multiple central catheters and upper extremity prosthetic arteriovenous grafts. A successful second transplantation eliminated her need for hemodialysis, but a right brachial to internal jugular graft remained patent. Progressive visual loss 2 years after transplantation prompted ophthalmic evaluation which initially revealed unilateral left optic nerve edema and visual loss, ultimately worsening over several months to no light perception in the left eye, 20/60 vision in the right eye, and bilateral papilledema. Arteriography demonstrated cerebral venous hypertension attributed to the functioning hemoaccess graft. Permanent graft occlusion normalized the papilledema, and visual field defects in the right eye and visual acuity returned to 20/20 in the right eye.
Cuadra
Salvador A
SA
University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA.
Padberg
Frank T
FT
Turbin
Roger E
RE
Farkas
Jeffrey
J
Frohman
Larry P
LP
D001766:Blindness / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications* / Q000000981:diagnostic imaging; D006084:Graft Rejection; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011859:Radiography; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome