Unilateral papilloedema after hepatitis B vaccination in a migraine patient, A case report including forensic aspects

Abstract

ABSTRACT.Purpose: To report on a unilateral optic nerve reaction appearing 9-10 hours after vaccination against hepatitis B. Methods: To describe the case and discuss the underlying mechanisms. There was a scintillating scotoma leaving a permanent inferior notch in the visual field, but central vision was left normal and with only a slight affection of colour perception. Shortly the optic nervehead appeared engorged, then slightly ischaemic, but was hardly left with evidence of atrophy. Results: Immune-based reactions could hardly be held responsible, multiple sclerosis was unlikely, and ultrasonography excluded optic nervehead drusen. An optic nerve migraine mechanism is probable, possibly with the vaccination having acted as the trigger.

Ocular effects caused by viral infections and corresponding vaccines: An overview of varicella zoster virus, measles virus, influenza viruses, hepatitis B virus, and SARS-CoV-2

“…Reported ocular complications occurring after the administration of the vaccine included uveitis ( 112 – 114 ), which is the most common manifestation and typically appears 3 days or more following the first dose of the vaccine but rarely occurs again after the second and third dose ( 123 , 124 ). The posterior segment and the optic nerve resulted also potentially involved, with MEWDS ( 125 ), APMPPE ( 126 , 127 ), central retinal vein occlusion ( 113 , 128 ), papilledema ( 129 ) and optic neuritis ( 113 , 130 , 131 ).…”

Unilateral optic neuropathy associated with sildenafil intake

“…Initially, however, the papilloedema was not typically pale but appeared slightly ‘choked’. Ophthalmoscopically, we have had similar initial experiences with previous patients in whom NAION became manifest (Fledelius 1999a, 1999b).…”

“…Ophthalmoscopically, we have had similar initial experiences with previous patients in whom NAION became manifest (Fledelius 1999a(Fledelius , 1999b.…”

Unilateral Papilledema in Cerebral Venous Sinus Thrombosis

“…[ 11 ] As subarachnoid space is continuous around the brain and extends around the optic nerve as perioptic space, papilledema is seen bilaterally though can be asymmetrical on few occasions. Unilateral papilledema is rare in patients with raised intracranial pressure and has been sporadically reported in idiopathic intracranial hypertension,[ 1 2 3 ] intracranial tumors (Foster–Kennedy syndrome [FKS]),[ 12 ] ocular-orbital pathologies (Optic sheath tumor),[ 13 ] after vaccine administration,[ 14 ] tumor infiltration[ 15 ] and in patients with differences in IOP after trabeculectomy surgery for the eyes. [ 16 ]…”