Papilledema eye disorders merck manuals professional edition. Other symptoms may be caused by the elevated pressure in the brain. Distinguishing it from other optic neuropathies that produce elevated optic discs is challenging, especially in the chronic phase, when visual function may be impaired. Differentiating papilledema from other causes of a swollen optic disk, such as optic neuritis, ischemic optic neuropathy, hypotony, central retinal vein occlusion, uveitis, or pseudo swollen disks eg, optic nerve drusen, requires a thorough ophthalmologic evaluation. R a manual and atlas of medical ophthalmoseopy, phila. The picture of an otogenic intracranial complication is emerged when a patient with ear discharge develops headache, vomiting, neck rigidity, and papilloedema. Her best corrected visual acuity was 1010 in both eyes. Papilledema eye disorders msd manual professional edition.
Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The etiology for the high icp or intracranial hypertension. Papilledema is frequently bilateral and symmetric, but may be asymmetric or unilateral. Oct 17, 2017 if tests reveal a medical problem, treating it should cure papilledema as well. Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed tomography ct.
Papilledema eye disorders merck manuals professional. This article is from journal of clinical neurology seoul, korea, volume 8. Funduscopy revealed severe bilateral papilledema figure 1. Bilateral papilledema in otherwise well patients jama. Bilateral papilledema secondary to obstructive or communicating hydrocephalus in patients with vestibular schwannomas is a known presentation. Fleeting vision changesblurred vision, double vision, flickering, or complete loss of visiontypically lasting seconds are characteristic of papilledema. Secondary intracranial hypertension is a rare complication of guillainbarre syndrome gbs. The mri appearance relates to the dural anatomy of the optic nerve, which is continuous with the subarachnoid space, thereby allowing increased intracranial pressure icp to be transmitted to the optic disc. If papilledema is suspected clinically, magnetic resonance imaging mri. Papilledema can happen over a time frame of hours to weeks. Pseudotumor cerebri as an important differential diagnosis.
Papilledema is nearly always bilateral, is accompanied by loss of venous pulsations, and varies in appearance from mild to severe fig. Papilledema is sometimes found at routine examination in an asymptomatic individual. Papilledema occurs when raised intracranial pressure is transmitted to the optic nerve sheath. Papilledema is a swelling of this nerve where it meets the eye the optic disc caused by an increase in intracranial pressure. Sep 04, 2019 papilledema is an optic disc swelling that is secondary to elevated intracranial pressure. The increased csf pressure is transmitted to the optic nerve, resulting in stasis of axoplasmic flow causing. Bilateral optic disc drusen mimicking papilloedema. Information concerning such a condition is abundant in neurological and neurosurgical journals, but relatively little has been written in the ophthalmological literature.
This topic will provide an overview and differential diagnosis of papilledema. Bilateral optic disc drusen mimicking papilledema 152 j clin neurol 2012. Most cases of papilledema are bilateral, although the optic nerve appearance. Choose from 29 different sets of papilledema flashcards on quizlet. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Papilledema bilateral blurred disc margins in the right optic nerve.
Papilledema can be observed in people of any age, but is relatively. Symptoms of increased intracranial pressure include headache or nausea and vomiting. The history should be taken, and a physical examination, including vital signs, should be performed. Swelling of the optic nerve due to other causes such as infection or inflammatory disease is not called papilledema. Her best corrected visual acuity was 810 in the right eye and 1010 in the left eye. Sep 04, 2019 papilledema is sometimes found at routine examination in an asymptomatic individual. Grade v papilledema has the criteria of grade iv plus partial or total obscuration of all vessels of the disc.
We describe a case with clinical, and neurophysiological evidence of gbs with headache and progressive bilateral vision loss 3 weeks after the onset of weakness. This swelling is a reaction to a buildup of pressure in or around your brain that may have many causes often, its. In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema. Their symptoms and signs improved dramatically after treatment of the anemia. Papilledema eye disorders merck manuals consumer version. On ocular examination, a posterior capsular cataract was the only remarkable finding of both anterior segments. Papilledema is swelling of the optic nerves that occurs in response to increased pressure in the head i.
Papilledema is a condition in which increased pressure in or around the brain intracranial pressure causes swelling of the part of the optic nerve inside the eye. Unilateral or bilateral optic disc swelling requires the clinician to obtain a thorough history and perform a detailed general, neurologic, and ophthalmologic exam. To present a female child patient with osteogenesis imperfecta who had bilateral papilledema. Papilledema is often an unrecognized cause of optic disc edema in inflammatory and compressive meningeal disorders that interfere with cerebrospinal fluid.
The ophthalmologist is frequently called upon to evaluate a case in which bilateral papilledema is the only finding. Primary pseudotumor cerebri ptc in childhood is a rare but important differential diagnosis in children presenting with papilledema. Papilledema article about papilledema by the free dictionary. All had severe iron deficiency anemia, which was discovered at the time of their ocular complaints in five of them.
Papilledema is clinically defined as optic disc swelling secondary to increased intracranial pressure icp. A recent ct scan of the head arranged by his general practitioner had shown no. The elevated pressure in the head pushes on the optic nerve. Vestibular schwannoma presenting with bilateral papilledema. On further questioning she reported intermittent episodes of blurred vision. The occurrence of papilledema with severe anemia is a very rare phenomenon. A woman, aged 21 years, presented to her general practitioner with a 1month history of severe headaches. Optic disc swelling can be caused by a number of conditions. Papilledema and obstructive sleep apnea syndrome neuro. Bilateral papilledema in otherwise well patients jama network. It usually happens bilateral which means it happens in both eyes. Longterm complications of chronic hypocalcaemia like bilateral cataract, papilledema and basal ganglia calcification are rare.
Often an ophthalmologist a medical doctor who specializes in the evaluation and treatment of eye disorders needs to confirm the diagnosis and help determine the cause. To diagnose papilledema, a doctor uses an ophthalmoscope a light with magnifying lenses that is used to look into the back of the eye. At first, papilledema may be present without affecting vision. In particular, check the blood pressure to exclude malignant hypertension.
A case of cerebral venous sinus thrombosis article pdf available in oman journal of ophthalmology 71. There were no postural variation in symptom intensity, pulsatile tinnitus or additional neurological symptoms. The incidence of papilledema is equal in men and women and may also occur at any age as long as the causes are present. A 20yearold female patient was referred from another clinic with a diagnosis of bilateral papilledema. All had bilateral papilledema associated with peripapillary hemorrhages. Visual loss is a serious complication, which requires careful monitoring and. In 1 patient, continuous 24hour intracranial pressure icp monitoring was also performed. It is defined as elevated cerebrospinal fluid csf pressure of more than 20 cm h 2 o, normal csf composition, and exclusion of underlying structural or systemic causes. Optic disc swelling including papilloedema patient. Papilledema definition of papilledema by medical dictionary. The causes are protean, a veritable augean stable of conditions see below, the most common of which. Pdf papilledema is a rare but recognized complication of hypocalcaemia with. The entity of increased intracranial pressure and specific causes. Vision problems are not common initially, but may include short flickers of gray vision, blurred or double vision, and decreased field of vision.
Papilledema pe is acquired bilateral optic disc swelling attributed to. Grade iii papilledema is characterized by loss of major vessels as they leave the disc arrow grade iv papilledema is characterized by loss of major vessels on the disc. He complained of a 4week history of intermittent headache and a 2day history of blurred vision in his right eye. Papilledema eye disorders msd manual consumer version. Papilledema is defined as optic disc edema caused by elevated intracranial pressure icp and should be distinguished from papillitis. Under certain special circumstances, papilledema can be unilateral. Headache, nausea, vomiting, or a combination may occur. Papilledema definition, pictures, causes, symptoms, treatment. Papilledema definition, pictures, causes, symptoms. Learn papilledema with free interactive flashcards. Intracranial complications of chronic suppurative otitis media.
Jun 29, 2012 a 20yearold female patient was referred from another clinic with a diagnosis of bilateral papilledema. You may find the idiopathic intracranial hypertension article more useful, or one of our other health articles. The time required for papilledema to evolve into optic atrophy depends on severity, and duration of the iicp. Results all 4 patients had bilateral pe that was asymmetric in 2.
Bilateral papilledema in hypocalcemia article pdf available in delhi journal of ophthalmology 232 september 2015 with 345 reads how we measure reads. Chronic papilledema leads to nerve fiber layer atrophy figure 6 6. Three patients had optic nerve dysfunction, asymmetric. Papilledema is an ophthalmoscopic diagnosis and refers to swelling of the optic disc. Papilloedema is a diagnostic term used exclusively to describe optic disc. A young adult male was referred by his optometrist for suspected papilloedema. We report a case of a 20yearold woman presenting with visual deterioration and bilateral papilledema on fundoscopy. Papilledema genetic and rare diseases information center. The optic nerve carries images from your eye to your brain. A 61yearold man presented with a 4month history of progressive vision loss and paresthesia between the right l2l4 dermatome. The raised pressure mechanically disrupts axoplasmic flow within the nerve.
Tell a friend about us, add a link to this page, or visit the webmasters page for free fun content. Sinclair aj, burdon ma, nightingale pg, matthews td. Csf from a lumbar puncture at the l4l5 level was xanthochromic with an elevated protein level 4,350 mgdl. Evaluation of two nonmyasthenic patients with ptosis in his neurological examination, he did not have any pathology other than papilledema and hypoactive deep tendon reflexes.
Bilateral papilledema was found in the fundoscopic examination of the patient whose headache increased gradually. This is a condition that can be found in all age groups but it is fairly uncommon to find it in infants because the bones of their skulls are not fully fused together yet. When illuminated with a redfree light these retractile bodies will auto fluoresce. Fundoscopic examination showed bilateral papilledema with retinal hemorrhages. Papilloedema article about papilloedema by the free. Almost all cases of papilledema are bilateral affect both eyes. This material will help you understand papilledema. Office and emergency room diagnosis and treatment of eye disease.
It is considered an emergency because intracranial pressure may rise in an exponential fashion with the potential for acute neurologic decompensation. Papilledema is swelling of your optic nerve, which connects the eye and brain. Overview and differential diagnosis of papilledema uptodate. Bilateral papilledema in a child with osteogenesis imperfecta. Two had retinal cottonwool spots cws, and two had preretinal hemorrhages. Methods a series of 4 patients with sas and papilledema pe underwent complete neuroophthalmologic evaluation and lumbar puncture. She was overweight and had a body mass index bmi of 32 kgm 2. Foster kennedy syndrome intracranial lesions that exert pressure on one optic nerve often leads to unilateral optic atrophy if these lesions are large enough, they.
Papilledema is bilateral optic disc swelling due to increased intracranial pressure. Pdf bilateral papilledema in hypocalcemia researchgate. Despite the high incidence of irondeficiency anemias of all etiologies, the literature covering the past 50 years cites only 12 cases of papilledema related to anemia alone 1. Papilledema definition papilledema is a swelling of the optic nerve, at the point where this nerve joins the eye, that is caused by an increase in fluid pressure within the skull intracranial pressure. Papilloedema article about papilloedema by the free dictionary. He had a right sixth cranial nerve palsy and bilateral disc oedema. Papilledema associated with blood loss anemia annals of. Papilloedema associated with dural venous sinus thrombosis o. It is our purpose to report a case of papilledema related to chronic bloodloss anemia which was completely reversed by correction of the anemia. Papilledema differential diagnoses medscape reference. Papilledema is swelling of the optic nerve s due to increased intracranial pressure. Papilledema definition of papilledema by the free dictionary. A twelveyearold girl with osteogenesis imperfecta was referred to our clinic. The optic nerve is the nerve that transmits signals from the eye to the brain.
Pdf evaluation and treatment of papilledema in pregnancy. While the term papilledema is often used broadly to denote a swollen optic nerve head, the term papilledema should be reserved for optic disc swelling that is due to raised intracranial pressure. Fundus picture papilledema image by the eyes have it papilledema is usually bilateral see why papilledema occurs bilaterally. Sep 20, 2017 papilledema is a condition that affects the eyes. Doctors make the diagnosis by looking in the persons eye with an ophthalmoscope. It most commonly presents bilaterally, but may be asymmetric or unilateral as well. Optic disc drusen, which are calcified deposits that form. Papilledema is a sign of elevated intracranial pressure and is almost always bilateral. They are written by uk doctors and based on research evidence, uk and european guidelines. She was considered to have bilateral papilledema and consulted with our department for lumbar puncture evaluation.
Obstipation of intraaxonal fluid results in swelling of the axons and leakage of water, protein, and other cellular contents into the extracellular space of the optic disc. Professional reference articles are designed for health professionals to use. The swelling is usually bilateral and can occur over a period of hours to weeks. Papilledema most commonly occur as bilateral, which means that both eyes are affected. Cureus vestibular schwannoma presenting with bilateral. Icp but sometimes asymmetrically in the 2 eyes and rarely in 1 eye only. Papilledema is a condition in which increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell.