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April 2007

Central Retinal Venous Occlusion and Cerebral Venous Thrombosis—Reply

Arch Neurol. 2007;64(4):609. doi:10.1001/archneur.64.4.609-b

In reply

We thank Turan and colleagues for their comments regarding the funduscopic findings for our patient with CRVO.1 Optic disc swelling combined with exudates, cotton wool spots, and peripapillary hemorrhages can be observed in CRVO, particularly the ischemic type, as well as severe papilledema caused by marked increased intracranial pressure.2 The funduscopic findings for our patient were associated with the clinical alterations suggesting CRVO. At admission, the patient suffered from a decrease in visual acuity, which is an unusual manifestation of acute onset of papilledema.3 The patient had only mild headache without nausea or disturbed mental status, which suggests marked increased intracranial pressure. No mass or parenchymal lesion was observed on initial magnetic resonance images, even though thrombus was observed in the left lateral sinus. We think that the clinical, imaging, and funduscopic findings for the patient were developed by CRVO associated with cerebral venous thrombosis rather than severe papilledema. The early and successful anticoagulation for our patient showed the importance of early anticoagulation for the rapid improvement of CRVO without hemorrhagic effects.

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