Visual outcomes and headache in intracranial hypertension following cerebral venous sinus thrombosis: A retrospective cohort study
- 1Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- 2Department of Otorhinolaryngology, Helios Hospital Berlin-Buch, Berlin, Germany
- 3Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Berlin, Germany
Abstract
Intracranial hypertension is a frequent complication of cerebral venous sinus thrombosis (CVT), posing a risk for permanent visual impairment. However, long-term visual outcomes have not been systematically assessed using objective neuro-ophthalmic measures. We retrospectively evaluated consecutive adults presenting to a single-center tertiary intracranial hypertension clinic between 2019 and 2025 with intracranial hypertension following CVT. Visual outcomes were assessed using best-corrected visual acuity, automated perimetry, and optical coherence tomography measuring global peripapillary retinal nerve fiber layer thickness. Headache phenotype and medication overuse were documented. Nineteen patients (11 female; mean age 33.4 ± 12.1 years) were included, with a mean follow-up of 3.4 ± 2.4 years after diagnosis of CVT-related intracranial hypertension. The transverse sinus was involved in 78.9% of cases, and complete or near-complete recanalization was achieved in 68.4%. Although visual acuity remained normal in most patients (84.2%), 26.3% had severe visual field loss and 15.8% showed retinal nerve fiber layer thinning. Headache persisted in 94.7%, most commonly as tension-type headache (63.2%), and 26.3% fulfilled criteria for medication overuse headache. Despite generally preserved visual acuity, substantial visual field deficits and persistent headache were common in CVT-related intracranial hypertension. These findings support routine neuro-ophthalmic follow-up to facilitate early detection of visual deterioration in CVT-related intracranial hypertension. As this cohort was drawn from a specialized tertiary referral clinic, these findings should be interpreted as hypothesis-generating rather than representative of the broader CVT population.
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BibTeX
@article{knoche2026visual,
title = {{Visual outcomes and headache in intracranial hypertension following cerebral venous sinus thrombosis: A retrospective cohort study}},
author = {Theresia Knoche and Ivo Grueninger and Charlotte Pietrock and Zohreh Jami and Leon Alexander Danyel},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0362200},
url = {https://doi.org/10.1371/journal.pone.0362200},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Visual outcomes and headache in intracranial hypertension following cerebral venous sinus thrombosis: A retrospective cohort study
AU - Theresia Knoche
AU - Ivo Grueninger
AU - Charlotte Pietrock
AU - Zohreh Jami
AU - Leon Alexander Danyel
PY - 2026
DA - 2026/11/06
JO - PLOS One
DO - 10.1371/journal.pone.0362200
UR - https://doi.org/10.1371/journal.pone.0362200
AB - Intracranial hypertension is a frequent complication of cerebral venous sinus thrombosis (CVT), posing a risk for permanent visual impairment. However, long-term visual outcomes have not been systematically assessed using objective neuro-ophthalmic measures. We retrospectively evaluated consecutive adults presenting to a single-center tertiary intracranial hypertension clinic between 2019 and 2025 with intracranial hypertension following CVT. Visual outcomes were assessed using best-corrected visual acuity, automated perimetry, and optical coherence tomography measuring global peripapillary retinal nerve fiber layer thickness. Headache phenotype and medication overuse were documented. Nineteen patients (11 female; mean age 33.4 ± 12.1 years) were included, with a mean follow-up of 3.4 ± 2.4 years after diagnosis of CVT-related intracranial hypertension. The transverse sinus was involved in 78.9% of cases, and complete or near-complete recanalization was achieved in 68.4%. Although visual acuity remained normal in most patients (84.2%), 26.3% had severe visual field loss and 15.8% showed retinal nerve fiber layer thinning. Headache persisted in 94.7%, most commonly as tension-type headache (63.2%), and 26.3% fulfilled criteria for medication overuse headache. Despite generally preserved visual acuity, substantial visual field deficits and persistent headache were common in CVT-related intracranial hypertension. These findings support routine neuro-ophthalmic follow-up to facilitate early detection of visual deterioration in CVT-related intracranial hypertension. As this cohort was drawn from a specialized tertiary referral clinic, these findings should be interpreted as hypothesis-generating rather than representative of the broader CVT population.
SN - 1932-6203
ER -