Methods a series of 4 patients with sas and papilledema pe underwent complete neuroophthalmologic evaluation and lumbar puncture. Any reported unilateral papilledema should be viewed skeptically and is more likely optic disc edema. Its common to have blurred or double vision, and lose. In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema. Bilateral papilledema papilledema most commonly occur as bilateral, which means that both eyes are affected. 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 is an optic disc swelling that is secondary to elevated intracranial pressure. Papilledema is relatively uncommon in infants due to the lack of fusion of skull bones. Alternatively, you can download the file locally and open with any standalone pdf reader. Fundoscopic examination showed bilateral papilledema with retinal hemorrhages.
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. 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. Jacobson 15 found bilateral flattening of the posterior sclera and distension of the perioptic sas on mr imaging in a patient with elevated icp and unilateral papilledema. Often, its a warning sign of a serious medical condition that needs attention. It is considered an emergency because intracranial pressure may rise in an exponential fashion with the potential for acute neurologic decompensation. What are the symptoms and complications of papilledema. Her best corrected visual acuity was 810 in the right eye and 1010 in the left eye. Answer if tests reveal a medical problem, treating it should cure papilledema as well. Patient with bilateral, somewhat asymmetric papilledema. In three of the four patients with globular subhyaloid hemorrhage, the bleeding was adjacent to the optic disc. This swelling is a reaction to a buildup of pressure in or around your brain. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Papilledema and idiopathic intracranial hypertension. Papilledema is swelling of the optic nerves that occurs in response to increased pressure in the head i.
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 is a pdf file of an unedited manuscript that has been accepted for publication. Pdf evaluation and treatment of papilledema in pregnancy. Multiple bilateral retinal hemorrhages associated with chronic papilledema case 10. Optic disc swelling can be caused by a number of conditions including papilloedema. Papilledema occurs when raised intracranial pressure is transmitted to the optic nerve sheath. The elevated pressure in the head pushes on the optic nerve. Calhoun mayo clinic jacksonville, florida uploaded on jul 14, 20. Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause.
Evaluation and treatment of papilledema in pregnancy. An imaging test, such as magnetic resonance imaging mri, can provide. 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. Papilledema is defined as optic disc edema caused by elevated intracranial pressure icp and should be distinguished from papillitis. Papilledema is clinically defined as optic disc swelling secondary to increased intracranial pressure icp. With chronic papilledema a person could develop optic atrophy which is a dysfunction of your optic nerve that results in having impaired vision. This topic will provide an overview and differential diagnosis of papilledema. Bilateral papilledema in a child with osteogenesis imperfecta. Since the optic nerve is connected with the subarachnoid space, both sides of the optic nerve receive transmission of an increased intracranial pressure. Overview and differential diagnosis of papilledema uptodate. Bilateral papilledema and partially empty sella in a woman. Three months later, the visual field of her left eye became normal, while the blindness of her right eye was irreversible. Papilledema eye disorders msd manual consumer version.
On ocular examination, a posterior capsular cataract was the only remarkable finding of both anterior segments. Objectives to characterize the pathogenesis and clinical features of optic disc edema associated with obstructive sleep apnea syndrome sas. Rating appears in papilledema conditionkeywords papilledema. Atta and byrne 14 noted flattening of the posterior sclera on sonography in some patients with choroidal folds and papilledema. Papilledema is a rare but recognized complication of hypocalcaemia with primary or surgically induced hypoparathyroidism.
Bilateral peripapillary neovascularizations in pseudotumor cerebri were reported by morse et al. 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. Ophthalmologic and systemic examinations were performed. The etiology for the high icp or intracranial hypertension ih may be known eg, brain tumor, meningitis.
This range of appearances can be described by using the frisen scale table 245. Doctors make the diagnosis by looking in the persons eye with an ophthalmoscope. Papilledema definition, pictures, causes, symptoms. Papilledema most commonly occur as bilateral, which means that both eyes are affected. Optic disc drusen, which are calcified deposits that form anterior to the lamina cribrosa in the optic nerve, may mimic papilledema. Pdf papilledema is defined as optic disk edema that is secondary to increased intracranial pressure. These files will have pdf in brackets along with the filesize of the download. By definition, papilledema cannot exist in the absence of high icp, but high icp can occur in the absence of papilledema. Bilateral papilledema in otherwise well patients jama. Cotton wool infarcts were confined to the peripapillaryarea, and deepexudateswere notpresentin any patient.
The diagnosis of cerebral venous thrombosis cvt remains challenging due to a wide range of clinical manifestations. Papilledema and peripheral neuropathies request pdf. A case of bilateral uveitis and optic disc swelling with. A 16yearold girl was admitted to our clinic due to conjunctival hyperaemia and blurred vision in her right eye. The increased csf pressure is transmitted to the optic nerve, resulting in stasis of axoplasmic flow causing.
The ophthalmologist is frequently called upon to evaluate a case in which bilateral papilledema is the only finding. Papilledema may also be referred to as papillary stasis or choked disk. Answer eye doctors use a tool called an ophthalmoscope to look inside the back of the eyes. The differential diagnoses for papilledema in a patient of this age include. 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. In intracranial hypertension, the optic disc swelling most commonly occurs bilaterally. 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 giving rise to optic disc edema 1,2.
A mild case of papilledema with symptoms that dont disrupt your life is nothing to worry about. The optic nerve carries images from your eye to your brain. The incidence of papilledema is equal in men and women and may also occur at any age as long as the causes are present. Pdf bilateral optic disc drusen mimicking papilledema. Pdf most of the documents on the racgp website are in portable document format pdf. Differentiating mild papilledema and buried optic nerve head drusen using spectral domain optical coherence tomography. Pdf the term papilledema refers to the edema that appears in the optic papilla after intracranial hypertension. 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. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed.
Papilledema is mostly seen as a symptom resulting from another pathophysiological process. A line scan through the papillomacular bundle demonstrating retrodisplacement of. This swelling is a reaction to a buildup of pressure in or around your brain that may have many causes often, its. Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure. Differentiating mild papilledema and buried optic nerve. Most cases of papilledema are bilateral, although the optic nerve appearance can be asymmetric. Patients with papilloedema usually present with signs or symptoms of raised icp. Pdf papilledema and idiopathic intracranial hypertension. Five patients had obvious but circumscribed vitreous bleeding.
Swelling of your optical nerve is not the only symptom. Information concerning such a condition is abundant in neurological and neurosurgical journals, but relatively little has been written in the ophthalmological literature. Papilledema is swelling of your optic disc, the place where the nerve that goes to your brain connects inside your eye. Papilledema is frequently bilateral and symmetric, but may be asymmetric or unilateral. To open a pdf file you will need compatible software.
Optic disc swelling including papilloedema patient. Papilledema definition of papilledema by medical dictionary. But papilledema can be a sign of an underlying condition or injury that needs to be treated as soon as possible. When a person first gets papilledema there are few symptoms. Papilledema differential diagnoses medscape reference. The elevated pressure in the head pushes on the optic nerve and makes your optic nerve swell. Asymmetric papilledema american academy of ophthalmology.
Papilledema eye disorders msd manual professional edition. As a service to our customers we are providing this early version of the manuscript. The swelling is usually bilateral and can occur over a period of hours to weeks. Papilledema is an eye condition that happens when pressure in your brain makes your optic nerve swell. This case reminded us that when empty sella meets bilateral papilledema, intracranial hypertension should be considered even in the absence of neurologic symptoms, and cvt can be one of the possible diagnoses. Papilledema is nearly always bilateral, is accompanied by loss of venous pulsations, and varies in appearance from mild to severe fig. We report herein three cases referred to us with suspicion of. A twelveyearold girl with osteogenesis imperfecta was referred to our clinic. Based on the findings of severe bilateral papilledema in the context of elevated csf pressure, endstage renal disease, hyperostosis of the skull, and the otherwisenegative results of workup, the cause of the patients papilledema was bilateral jugular foraminal stenosis most likely secondary to renal osteodystrophy. Papilledema is swelling of your optic nerve, which connects the eye and brain. Papilledema is bilateral optic disc swelling due to increased intracranial pressure.
Bilateral papilledema in a child with osteogenesis. A 20yearold female patient was referred from another clinic with a diagnosis of bilateral papilledema. The term papilloedema refers specifically to optic disc swelling secondary to raised intracranial pressure icp. To present a female child patient with osteogenesis imperfecta who had bilateral papilledema. Answer as it progresses, youre likely to have vision problems, usually in both eyes. Papilledema and obstructive sleep apnea syndrome neuro. To diagnose papilledema, a doctor uses an ophthalmoscope a light with magnifying lenses that is used to look into the back of the eye. The raised pressure mechanically disrupts axoplasmic flow within the nerve. Swelling of the optic nerve due to other causes such as infection or inflammatory disease is not called papilledema. Papilledema eye disorders merck manuals consumer version. 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. We report a case of bilateral uveitis and optic disc swelling with chiari i malformation. Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination.