{
  "abstract": "Background Haemodialysis peripheral arteriovenous fistulas may rarely be associated with papilloedema and visual disturbance due to cerebral venous hypertension as a consequence of high fistula flow and central venous stenosis. While ocular involvement initially evolves slowly, it may rapidly result in permanent visual loss if not identified early.Case report We report a case of a 33-year-old male with a high flow left brachiocephalic fistula and severe left brachiocephalic vein stenosis who presented with face, upper limb swelling and elevated intraocular pressure ipsilaterally, but transient monocular visual obscurations and papilloedema contralaterally. He was successfully managed with stenting of the stenosis.Discussion All reported cases of papilloedema associated with peripheral arteriovenous fistulas share a common pathophysiology requiring a high flow fistula, central venous stenosis and retrograde internal jugular flow. Most patients present with slowly progressive unilateral or bilateral reduced visual acuity, invariably with swelling of the upper limb, neck and face. Notably, papilloedema often presents contralateral to the fistula and other associated symptoms. We propose that sparing of the ipsilateral eye occurs due to the elevated intraocular pressure that opposes raised intracranial pressure. Early definitive intervention with fistula ligation or central venous stenosis dilatation result in near complete resolution of symptoms, though delayed intervention can lead to permanent and severe vision loss. This case and the accompanying literature review, emphasise the need for vigilance in patients with high flow fistulas and central venous stenosis and the importance of timely diagnosis and management to achieve a favourable prognosis.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuro-ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia"
      ],
      "name": "Winston Dzau"
    },
    {
      "affiliations": [
        "Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia",
        "Department of Radiology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Conor Houlihan"
    },
    {
      "affiliations": [
        "Department of Neuro-ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia"
      ],
      "name": "Subahari Raviskanthan"
    }
  ],
  "title": "3400 Brachiocephalic vein stenosis complicated by contralateral papilloedema in the setting of a high flow brachiocephalic haemodialysis fistula: a case report",
  "uid": "10f746a0-03cc-5f91-b49d-bb27f6a45069"
}