Papilledema

Background

• Bilateral optic disc swelling due to increased ICP

Etiology

• Malignant hypertension
• Idiopathic intracranial hypertension (pseudotumor cerebri)
• Intracranial mass
• Hydrocephalus
• Cerebral edema

Clinical Features

• Increased ICP symptoms:
  • Headache (esp with recumbency and in the morning)
  • Nausea and vomiting
• Preservation of visual acuity
  • May have visual obscurations that clear completely lasting seconds

Fundoscopy

• Loss of spontaneous venous pulsations
• Disc margin blurring
• Cup is diminished or absent

Differential Diagnosis

• Malignant hypertension
• Idiopathic intracranial hypertension (pseudotumor cerebri)
• Intracranial mass
• Hydrocephalus
• Cerebral edema
• Salicylate toxicity

Evaluation

• MRI
• CT (if MRI unavailable)
• LP (if neuroimaging normal)
  • Opening pressure >25 considered abnormal

Management

• Treat underlying condition

See Also

• Increased ICP