Optic nerve swelling

Question 1

What would be the cause of papilloedema with headache that is worse on coughing/leaning forward. Patient is nauseous and has vomited many times.

Answer 1

Raised ICP

Question 2

What would be the cause of papilloedema with no other signs except resistant hypertension?

Answer 2

malignant hypertension

Question 3

What would be the cause of papilloedema with headache, 6th nerve palsy, normal MRI but bilateral disc swelling.

Answer 3

idiopathic intracranial hypertensions

• overweight women
• 20-30’s

Treatment:

• oral acetazolamide
• ventriculoperitoneal shunting
• optic nerve decompression (small hole made in sheath surrounding optic nerve)

Question 4

What would be the cause of papilloedema with acute vision loss, pain on eye movement, central scotoma.

Answer 4

Optic neuritis:
Inflammation or demyelination of the optic nerve = optic neuritis
• This is called papillitis if the optic head is affected (swollen)
• This is called retrobulbar neuritis if the optic nerve is affected more posteriorly with no disc swelling (optic disc not swollen)

S/S:
• Acute loss of vision that may progress over few days then slowly improve
• Pain on eye movement in retrobulbar neuritis
• Preceding history of viral illness in some cases
• Reduced visual acuity
• Reduced colour vision
• Central scotoma
area of depressed vision that corresponds with the point of fixation and interferes with central vision
• RAPD due to reduced optic nerve conduction

Treatment:
• MRI scan identifies ‘plaques’ of demyelinatione but patient must be suitably counseled beforehand as the diagnosis of MS is a clinical one and patient may not want to have the presence of other possible plaques confirmed
• Steroid treatment may speed up visual recovery