Papilledema

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Papilledema is defined as swelling of the optic disc that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare.

Papilledema is in general the result of transmission of increased intracranial pressure^[1] to the anterior end of optic nerve through optic nerve sheath.

Papilledema can be caused by conditions which increase intracranial pressure. An increase in the volume of any of the cranium contents, the brain, cerebrospinal fluid and / or blood can cause increased intracranial pressure.

Papilledema occurs in approximately 50% of patients with a brain tumor.

Papilledema should be distinguished from pseudopapilledema

Papilledema regresses if the underlying cause is treated and if not, can lead to vision loss.

Patients with papilledema usually present with signs and symptoms of increased intracranial pressure (headache, nausea, vomiting, diplopia, vision loss and altered consciousness) and can lead to vision loss if the underlying condition is not treated.

The signs of papilledema include blurring of the margins of the optic disc, edema, and hemorrhages on fundoscopy.

The mainstay of treatment of papilledema is to treat the underlying cause which is often increased intracranial pressure. Drugs are used to decrease intracranial pressure which either decrease cerebrospinal fluid (CSF) production or increase the outflow of CSF.

Surgical treatment of papilledema depends on the underlying cause. Various surgeries including shunt surgeries, craniotomies and optic nerve sheath fenestration can be done depending on the cause.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Papilledema is in general the result of transmission of increased intracranial pressure^[1] to the anterior end of optic nerve through optic nerve sheath.

• The optic nerve sheath is contiguous with the subarachnoid space of the brain and is regarded as an extension of the central nervous system.

• The cranium and the vertebral body, along with the relatively inelastic dura, form a rigid container, such that an increase in any of the contents of the dura (brain, blood and cerebrospinal fluid) can cause increased intracranial pressure.

• The increased intracranial pressure is transmitted through to the optic nerve via the optic nerve sheath.

• The anterior end of the optic nerve stops abruptly at the eye. Hence the pressure is asymmetrical and this causes a pinching and protrusion of the optic nerve at its head.

• The fibers of the retinal ganglion cells of the optic disc become engorged and bulge anteriorly.

• Persistent and extensive optic nerve head swelling, or optic disc edema, can lead to loss of these fibers and permanent visual impairment.

• Papilledema may be absent in cases of prior optic atrophy. In these cases, the absence of papilledema is most likely secondary to a decrease in the number of physiologically active nerve fibers.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Papilledema can be caused by conditions which increase intracranial pressure. An increase in the volume of any of the cranium contents, the brain, cerebrospinal fluid and / or blood can cause increased intracranial pressure.

• Brain tumor
• Cerebral edema
• Cerebral venous sinus thrombosis
• Choroid plexus neoplasm
• Hydrocephalus
• Hypertension
• Idiopathic intracranial hypertension
• Intracranial bleeding
• Meningitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Papilledema should be distinguished from pseudopapilledema

Papilledema should be distinguished from pseudopapilledema which is caused by

• Optic disc drusen:^[1] These are globules of mucoproteins and mucopolysaccharides that progressively calcify. They are thought to be the remnants of the axonal transport system of degenerated retinal ganglion cells. Optic disc drusen have also been referred to as congenitally elevated or anomalous discs, pseudopapilledema, pseudoneuritis, buried disc drusen, optic nerve head drusen and disc hyaline bodies. Ophthalmoscopy and B-scan ocular ultrasonography allow appropriate diagnosis of optic disc drusen, which mimics papilledema.^[2]This is important to avoid unnecessary interventions and anxiety

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Papilledema occurs in approximately 50% of patients with a brain tumor.

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Please help WikiDoc by adding more content here. It’s easy! Click here to learn about editing.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Papilledema regresses if the underlying cause is treated and if not, can lead to vision loss.

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