Papilledema: Difference between revisions
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*All causes of [[elevated intracranial pressure]] | *All causes of [[elevated intracranial pressure]] | ||
**[[Intracranial mass]] | **[[Intracranial mass]] | ||
**Decreased CSF resorption | **Decreased CSF outflow or resorption | ||
**Increased CSF production or cerebral blood flow | **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> | *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> | ||
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