Papilledema: Difference between revisions
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==Background== | ==Background== | ||
*Bilateral optic disc swelling due to increased ICP | *Bilateral optic disc swelling due to increased ICP | ||
*This may sometimes be a presenting complaint, referred by an eye care provider, though will usually have associated symptoms such as headache, altered mental status, or vision changes. | |||
===Etiology=== | ===Etiology=== | ||
*[[ | *All causes of [[elevated intracranial pressure]] | ||
* | **[[Intracranial mass]] | ||
*[[Intracranial mass]] | **Decreased CSF outflow or resorption | ||
*[[ | **Increased CSF production or cerebral blood flow | ||
*Most commonly caused by [[Idiopathic intracranial hypertension]] in individuals under 50.<ref name="Xie">Xie JS, et al. Papilledema: A review of etiology, pathophysiology, diagnosis, and management. ''Surv Ophthalmol''. 2022;67(4):1135-1159.</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 13: | Line 14: | ||
**[[Headache]] (esp with recumbency and in the morning) | **[[Headache]] (esp with recumbency and in the morning) | ||
**[[Nausea and vomiting]] | **[[Nausea and vomiting]] | ||
* | *Visual disturbance | ||
**May have visual obscurations that clear completely | **Visual acuity is usually normal or near-normal in the acute phase | ||
**May have transient visual obscurations (blurriness or white out) that last seconds, then clear completely.<ref name="Xie" /> | |||
***These may be triggered by position change or Valsalva | |||
===Fundoscopy=== | ===[[Fundoscopy]]=== | ||
[[File:Papilledema.jpg|thumb|]] | |||
*Loss of spontaneous venous pulsations | *Loss of spontaneous venous pulsations | ||
*Disc margin blurring | *Disc margin blurring | ||
| Line 22: | Line 26: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Idiopathic intracranial hypertension]] (other causes must be excluded) | |||
*[[Idiopathic intracranial hypertension]] ( | |||
*[[Intracranial mass]] | *[[Intracranial mass]] | ||
*[[Hydrocephalus]] | *[[Hydrocephalus]] | ||
*[[Cerebral venous thrombosis]] | |||
*Cerebral edema | *Cerebral edema | ||
*[[Salicylate toxicity]] | **[[Ischemic stroke]] | ||
**[[Head trauma (main)|Traumatic brain injury]] | |||
**[[Salicylate toxicity]] | |||
**[[Meningitis]] | |||
**[[Encephalitis]] | |||
**[[Posterior reversible encephalopathy syndrome]] | |||
==Evaluation== | ==Evaluation== | ||
*MRI | *Careful [[neurologic exam]] including level of consciousness, pupils, and cranial nerves (especially CN VI-Abducens) | ||
*CT | *Fundoscopic exam without dilation is often difficult - consider [[ocular ultrasound]] to assess optic nerve diameter | ||
*[[ | *[[Brain MRI]] with MR venography to identify secondary causes of elevated ICP | ||
**Non-contrast head CT with CT venography may be a reasonable alternative depending on practice setting and patient urgency. Follow-up MRI may be required. | |||
*[[Lumbar Puncture]] (if neuroimaging normal) | |||
**Opening pressure >25 considered abnormal | **Opening pressure >25 considered abnormal | ||
Latest revision as of 21:11, 22 August 2025
Background
- Bilateral optic disc swelling due to increased ICP
- This may sometimes be a presenting complaint, referred by an eye care provider, though will usually have associated symptoms such as headache, altered mental status, or vision changes.
Etiology
- All causes of elevated intracranial pressure
- Intracranial mass
- Decreased CSF outflow or resorption
- Increased CSF production or cerebral blood flow
- Most commonly caused by Idiopathic intracranial hypertension in individuals under 50.[1]
Clinical Features
- Increased ICP symptoms:
- Headache (esp with recumbency and in the morning)
- Nausea and vomiting
- Visual disturbance
- Visual acuity is usually normal or near-normal in the acute phase
- May have transient visual obscurations (blurriness or white out) that last seconds, then clear completely.[1]
- These may be triggered by position change or Valsalva
Fundoscopy
- Loss of spontaneous venous pulsations
- Disc margin blurring
- Cup is diminished or absent
Differential Diagnosis
- Idiopathic intracranial hypertension (other causes must be excluded)
- Intracranial mass
- Hydrocephalus
- Cerebral venous thrombosis
- Cerebral edema
Evaluation
- Careful neurologic exam including level of consciousness, pupils, and cranial nerves (especially CN VI-Abducens)
- Fundoscopic exam without dilation is often difficult - consider ocular ultrasound to assess optic nerve diameter
- Brain MRI with MR venography to identify secondary causes of elevated ICP
- Non-contrast head CT with CT venography may be a reasonable alternative depending on practice setting and patient urgency. Follow-up MRI may be required.
- Lumbar Puncture (if neuroimaging normal)
- Opening pressure >25 considered abnormal
Management
- Treat underlying condition