Optic disc swelling is distinct from optic disc atrophy which refers to a loss of nerve fibres. Primary pseudotumor cerebri ptc in childhood is a rare but important differential diagnosis in children presenting with papilledema. Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. Papilledema is an ophthalmoscopic diagnosis and refers to swelling of the optic disc. Overview and differential diagnosis of papilledema uptodate. Papilledema eye disorders msd manual consumer version. On ocular examination, a posterior capsular cataract was the only remarkable finding of both anterior segments. The swelling is usually bilateral and can occur over a period of hours to weeks. There is a lack of inflammation, infiltration or infection of the optic nerve itself. A twelveyearold girl with osteogenesis imperfecta was referred to our clinic.
Office and emergency room diagnosis and treatment of eye disease. A 20yearold female patient was referred from another clinic with a diagnosis of bilateral papilledema. 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 you do not have it you can download adobe reader free of charge. Papilledema optic disc edema due to raised intracranial pressure. Methods case notes, blood tests, clinical photographs, and neuroimaging were collected and analyzed.
Papilledema optic disk swelling due to raised intracranial pressure. Papilledema is relatively uncommon in infants due to the lack of fusion of skull bones. The causes are protean, a veritable augean stable of conditions see below, the. Bilateral papilledema in a child with osteogenesis imperfecta. Optic fundus examination showed bilateral papilledema. 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. To diagnose papilledema, a doctor uses an ophthalmoscope a light with magnifying lenses that is used to look into the back of the eye. 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. Idiopathic intracranial hypertension and the evaluation of. Papilledema is swelling of the optic nerves that occurs in response to increased pressure in the head i. 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. Papilledema is swelling of your optic nerve, which connects the eye and brain.
The diagnosis of cerebral venous thrombosis cvt remains challenging due to a wide range of clinical manifestations. Bilateral papilledema due to increased intracranial pressure. Most cases of papilledema are bilateral, although the optic nerve appearance can be asymmetric. Pseudotumor cerebri as an important differential diagnosis. Pdf the term papilledema refers to the edema that appears in the optic papilla after intracranial hypertension.
Papilledema eye disorders msd manual professional edition. The ophthalmologist is frequently called upon to evaluate a case in which bilateral papilledema is the only finding. Review several causes of increased intracranial pressure and papilledema. Unilateral or bilateral optic disc swelling requires the clinician to obtain a thorough history and perform a detailed general, neurologic, and ophthalmologic exam to develop a broad differential diagnosis. Papilledema eye disorders merck manuals professional. Papilledema definition, pictures, causes, symptoms. Pdf most of the documents on the racgp website are in portable document format pdf. We report a case with primary hypocalcaemia who presented with bilateral cataract with papilledema as the first clinical manifestation. Careful history and examination are needed to distinguish papilloedema from other causes of optic disc swelling such as central retinal artery or vein occlusion, congenital abnormalities and optic neuritis. Headache is the most common presenting symptom and there can be other neurologic signs and symptoms, like focal seizures with or without secondary generalization, unilateral or bilateral paresis, impaired consciousness or visual disturbance. Papilledema indicates increased intracranial pressure. 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. Pdf papilledema is a rare but recognized complication of. Papilledema is important evidence of increased intracranial pressure transmitted through.
Pdf bilateral papilledema in hypocalcemia researchgate. A dilated fundus examination using a direct ophthalmoscope demonstrated bilateral disc swelling, disc hemorrhages and loss of spontaneous venous pulsations. Under certain special circumstances, papilledema can be unilateral. To open a pdf file you will need compatible software such as adobe reader. Her best corrected visual acuity was 810 in the right eye and 1010 in the left eye.
This swelling is a reaction to a buildup of pressure in or around your brain that may have many causes often, its. Swelling of the optic nerve in papilledema is most often bilateral and. Papilledema arising from hypertension is a medical crisis and the patient needs to be immediately hospitalized to avoid lifethreatening complications. Papilledema is nearly always bilateral, is accompanied by loss of venous pulsations, and varies in appearance from mild. Effect of optic nerve sheath fenestration on papilledema of the operated and the contralateral nonoperated eyes in idiopathic intracranial hypertension.
The elevated pressure in the head pushes on the optic nerve. Any edema of optic nerve head arising from causes other than increased intracranial pressure is termed optic disc edema, and not papilledema. 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. Pdf papilledema is optic disc swelling due to high intracranial pressure. Papilledema definition of papilledema by medical dictionary. Ef, 2 months after fenestration of the right optic nerve sheath, the. Funduscopic abnormalities usually precede visual disturbances. In addition to bilateral hyperemic and swollen optic disks optic nerve heads, patients typically have engorged and tortuous retinal veins, and retinal hemorrhages around the disk but not into the retinal periphery. This material will help you understand papilledema. The entity of increased intracranial pressure and specific causes. Papilledema vs papillitis with notes timothy zagada 1.
Papilledema most commonly occur as bilateral, which means that both eyes are affected. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Visual loss is a serious complication, which requires careful. She was overweight and had a body mass index bmi of 32 kgm 2. Bilateral papilledema in hypocalcemia abstract papilledema is a rare but recognized complication of hypocalcaemia with primary or surgically induced hypoparathyroidism. Cd, after resection of a meningioma, hemorrhages appeared and the papilledema worsened. She denied any other neurologic symptoms, such as headache, nausea, vomiting, seizures, and paresis. Doctors make the diagnosis by looking in the persons eye with an ophthalmoscope. A case of cerebral venous sinus thrombosis article pdf available in oman journal of ophthalmology 71. Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination.
Papilledema definition at, a free online dictionary with pronunciation, synonyms and translation. Papilledema pictures, definition, causes, symptoms and. This article is from journal of clinical neurology seoul, korea, volume 8. Ab, preoperative fundus pictures showing bilateral papilledema.
Irondeficiency anemia was treated with oral ferrous sulphate. Evaluation of two nonmyasthenic patients with ptosis in his neurological examination, he did not have any pathology other than papilledema and. These files will have pdf in brackets along with the filesize of the download. What is the differential diagnosis for papilledema in a patient of this age group. Noninvasive imaging of the on is possible by using mr imaging, with a variety of findings. Alternatively, you can download the file locally and open with any standalone pdf reader. Papilledema eye disorders merck manuals consumer version. 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. To present a female child patient with osteogenesis imperfecta who had bilateral papilledema. The unusual things in this case, were the profound visual loss normal cerebrospinal fluid profiles and the presentation of papilledema before the limb weakness. A woman in her 30s was referred for evaluation of bilateral papilledema and progressive visual loss in the right eye, which deteriorated to blindness in 3 months.
On further questioning she reported intermittent episodes of blurred vision. Papilledema genetic and rare diseases information center. Bilateral papilledema in a child with osteogenesis. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed. Optic disc drusen, which are calcified deposits that form. 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. Papilledema article about papilledema by the free dictionary. Optic disc swelling including papilloedema patient.
When no localizing neurological signs or spaceoccupying lesion is present, idiopathic intracranial hypertension iih is a likely cause in patients younger than age 45 years, especially obese women. Vision problems are not common initially, but may include short flickers of gray vision, blurred or double vision, and. A woman, aged 21 years, presented to her general practitioner with a 1month history of severe headaches. Papilledema is an eye condition that happens when pressure in your brain makes your optic nerve swell. The term papilledema refers specifically to optic disc swelling related to increased intracranial pressure. Information concerning such a condition is abundant in neurological and neurosurgical journals, but relatively little has been written in the ophthalmological literature. The incidence of papilledema is equal in men and women and may also occur at any age as long as the causes are present. In case of hypertension within the skull intracranial hypertension, the patient can have papilledema in one eye only. Effect of optic nerve sheath fenestration on papilledema. Papilledema differential diagnoses medscape reference. The increased csf pressure is transmitted to the optic nerve, resulting in stasis of axoplasmic flow causing.
Longterm complications of chronic hypocalcaemia like bilateral cataract, papilledema and basal ganglia calcification are rare. Bilateral papilledema and partially empty sella in a woman. Papilledema vs papillitis with notes timothy zagada. Papilledema is clinically defined as optic disc swelling secondary to increased intracranial pressure icp. Decompression of the optic nerve sheath for vision. It is considered an emergency because intracranial pressure may rise in an exponential fashion with the potential for acute neurologic decompensation. 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.
Any information contained in this pdf file is automatically generated from. Papilledema is bilateral optic disc swelling due to increased intracranial pressure. Swelling of the optic nerve due to other causes such as infection or inflammatory disease is not called papilledema. Bilateral papilledema was found in the fundoscopic examination of the patient whose headache increased gradually. Possible conditions causing high intracranial pressure and. International license, which allows users to download, copy and build. Visual loss with papilledema in guillainbarre syndrome.
Papilledema is nearly always bilateral, is accompanied by loss of venous pulsations, and. Bilateral blurred disc margins in the left optic nerves. Left papilledema due to increased intracranial pressure. Fundus picture papilledema image by the eyes have it papilledema is usually bilateral see why papilledema occurs bilaterally. Papilledema, defined as swelling of the optic disc, frequently occurs in the setting of increased icp and in a variety of medical conditions, including pseudotumor cerebri, sinus thrombosis, intracerebral hemorrhage, frontal lobe neoplasms, and chiari malformation. 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. Nerve conduction studies were suggestive of polyradiculopathy. Pdf evaluation and treatment of papilledema in pregnancy. Evaluation and treatment of papilledema in pregnancy.