A case of progressive and irreversible visual loss as a consequence of delayed diagnosis in cerebrospinal fluid venous fistula

Abstract

Purpose

Cerebrospinal fluid venous fistulas (CVFs) are a frequently underrecognized cause of cerebrospinal fluid (CSF) leaks, leading to intracranial hypotension and a wide range of symptoms, including visual disturbances. This case highlights the critical role of ophthalmologists in identifying CVFs as a cause of unexplained progressive vision loss.

Methods

We present the case of a 45-year-old woman who developed progressive visual field loss over 15 years, ultimately resulting in blindness in one eye. Early neuroimaging and testing were normal despite symptoms of orthostatic headaches, photophobia, and hearing loss. Advanced imaging eventually identified a CVF at the T8 level. Surgical correction was performed, and the patient's clinical response was assessed.

Results

Surgical repair of the CVF led to clinical improvement, halting further progression of symptoms.

Conclusions

CVFs should be considered in patients with unexplained visual disturbances, particularly when accompanied by symptoms of intracranial hypotension. Early suspicion and collaboration with neurologists and neuroradiologists are essential for timely diagnosis and intervention. Ophthalmologists play a pivotal role in guiding appropriate referrals, ensuring multidisciplinary care to prevent irreversible visual and systemic complications.