Persistent Papilledema After Cerebral Venous Sinus Thrombosis: A Prospective Observational Cohort Study

Objective: Papilledema is a clinically significant manifestation of cerebral venous sinus thrombosis (CVST) and reflects intracranial hypertension resulting from
impaired venous outflow. However, its severity and longitudinal course have not been adequately characterized. This study aimed to evaluate the longitudinal course
of papilledema in patients with CVST and to identify clinical and radiological factors associated with persistent papilledema.
Materials and Methods: This prospective observational study included 37 adult patients with radiologically confirmed CVST. Papilledema severity was assessed at
baseline and at six months using the Frisén grading scale. Persistent papilledema was defined as the presence of papilledema of any grade (≥1) at follow-up. Clinical
and radiological variables, including venous sinus involvement and recanalization status, were analyzed.
Results: Papilledema was present in 14 patients (37.8%) at baseline. At six months, papilledema had resolved in 5 patients but persisted in 9 patients (24.3% of the
cohort). The frequency of baseline Frisén grade 3–4 papilledema was significantly higher among patients with persistent papilledema than among those without
persistent papilledema (66.7% vs. 7.1%; p < 0.001). Magnetic resonance imaging (MRI) data were available for 25 patients, and complete recanalization was observed
more frequently in patients without persistent papilledema (p = 0.007). No significant associations were identified between persistent papilledema and demographic,
clinical, or other radiological variables.
Conclusion: Papilledema may persist in a substantial proportion of patients with CVST. Higher baseline papilledema grades were more frequently observed among
patients with persistent papilledema, whereas complete recanalization was more common among those without persistent papilledema. These findings support the
importance of structured neuro-ophthalmological follow-up in patients with CVST.