Clinical analysis of high altitude polycythemia manifested as bilateral papilledema

Abstract

Objective To investigate the clinical features, treatment and prognosis of high altitude polycythemia mainly manifested as bilateral papilledema. Methods Clinical data of 7 patients with high altitude polycythemia mainly manifested as bilateral papilledema in our hospital from March 2007 to September 2017 were retrospectively analyzed, including clinical manifestations, laboratory results, ophthalmologic examinations, head imaging features, mitochondrial gene detection, treatment and prognosis. Results There were 6 male patients and one female patient, with mean age (44.43 ± 9.05) years old, high altitude residence 7 (4, 13) months, and duration (28.43 ± 10.05) d. All patients were detected with high concentrations of hemoglobin (> 210 g/L), and different degrees of bilateral papilledema after onset. One eye had severe vision impairment [best corrected visual acuity (CVA) was finger counting], and the CVA of other 13 eyes were > 0.10. Visual field defects included enlargement of psychological blind spot (2 eyes), lower altitudinal visual field defect (4 eyes), central scotoma (2 eyes) and diffuse visual field defect (6 eyes). Brain MRI of 7 cases showed dot-like and patchy long T₁ and long T₂ signals in frontal lobe, parietal lobe and paraventricular region. Optic nerve MRI showed hyperintense signal and slight enhancement in 7 eyes and no abnormality in other 7 eyes. All patients were treated by antiplatelet therapy and microcirculation improvement. Best CVA of all patients were remarkably improved within follow up of 6 months. Conclusions High altitude polycythemia mainly manifested as bilateral papilledema was easily misdiagnosed as other diseases. Moving away from plateau, decreasing hemoglobin, anti-platelet therapy and microcirculation improvement may play an important role in the favorable prognosis.

DOI: 10.3969/j.issn.1672-1731.2019.02.008