Papilledema With Intracranial Hypertension and Ectopic Orbital Calcification During Hemodialysis: A Case Report

TL;DR

A 34-year-old woman on hemodialysis developed optic disc swelling and orbital calcification due to intracranial hypertension, requiring surgical intervention to prevent worsening vision.

Contribution

This case highlights a rare presentation of papilledema with ectopic orbital calcification in a hemodialysis patient.

Findings

The patient showed bilateral papilledema and progressive visual deterioration over six months.

Computed tomography revealed ectopic calcification in the sclera and optic nerve margin.

Hyperparathyroidism and intracranial hypertension were confirmed as contributing factors.

Abstract

Papilledema is optic disc swelling due to intracranial hypertension, which leads to progressive visual impairment. We report a rare case of papilledema with ectopic orbital calcification during hemodialysis. A 34-year-old woman with low body weight who was undergoing long-term hemodialysis presented with papilledema in both eyes, and her vision gradually deteriorated over the course of six months. The best corrected visual acuity was 20/16 in the right eye and 20/500 in the left eye, and fundus examination revealed significant optic disc swelling and visual field testing revealed nasal defects in both eyes and a central scotoma in the left eye. Computed tomography scan showed ectopic orbital calcification in the sclera and optic nerve margin. Orbital magnetic resonance imaging and magnetic resonance venography did not show optic neuritis or cerebral venous sinus thrombosis. Blood test results indicated hyperparathyroidism, which was considered to be a secondary change associated with long-term hemodialysis. Cerebrospinal fluid test confirmed intracranial hypertension, and treatment to reduce intracranial pressure was required to prevent the progression of visual impairment. Oral treatment was difficult, so surgical treatment was considered. Papilledema can be diagnosed from optic disc findings, and it is important to differentiate and search for various causes, including idiopathic intracranial hypertension, and to intervene at the appropriate time before visual impairment progresses.

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