Visual outcomes and headache in intracranial hypertension following cerebral venous sinus thrombosis: A retrospective cohort study

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.