Papilledema

Question 1

What are the 5 symptoms of papilledema?

Answer 1

1. HA
2. Nausea/Vomiting
3. Horizontal Diplopia
4. TVOs
5. Pulsatile Tinnitus

Question 2

What are the 5 features of papilledema?

Answer 2

1. Axoplasmic Stasis
2. Obscuration of Vessels
3. Paton’s lines
4. Extruded Axoplasm
5. Hemes

Question 3

What does the ICP have to be in order to have papilledema?

Answer 3

greater than 200-250mmH20

Question 4

How many SVP rhythmic beats must you view to r/o papilledema?

Answer 4

3-5 beats

Question 5

What must the ICP be to observe SVP?

Answer 5

< 180mmH20

Question 6

What are the 3 causes of pseudopapilledema?

Answer 6

1. Obesity
2. Anomalous disc (hypoplastic/drusen)
3. Migraines

Question 7

What are the main 3 tests to order of a patient suspected of having papilledema?

Answer 7

1. MRI w/ contrast- to look for a mass
2. MRV - to look for a blockage
3. Spinal tap - to determine ICP

Question 8

A (+) fluid sign on the lateral 30 degree test determines what?

Answer 8

Increased subarachnoid fluid, suggestive of papilledema

Question 9

If a tumor is present on a patient’s MRI, is a spinal tap still needed?

Answer 9

No! don’t do spinal tap if tumor present

- always do imaging before lumbar puncture

Question 10

What are the causes of increased ICP?

Answer 10

1. Obstruction of Flow (i.e. mass)
2. Blockage of venous sinus drainage
3. Elevated intra-abdominal pressure

Question 11

In order for a patient to be dx with Idiopathic Intracranial HTN, they have to meet all of Dandy’s Criteria. What are the 5 criterion?

Answer 11

1. Pt must be awake and alert
2. Must have SxS of increased ICP
3. No neurological signs except CN VI paresis
4. Normal imaging
5. CSF pressure > 200-250 mmH20

Question 12

What is the tx for IIH?

Answer 12

1. Weight loss (10% of body weight)
2. CAIs (Diamox)(1000mg/day)
3. Sx tx

Question 13

For a lumbar puncture, which area do they go in between?

Answer 13

Between L3 and L4

Question 14

What is the proven cause of IIH?

Answer 14

Obesity

Question 15

What is the likely cause of IIH?

Answer 15

1. Chlordecone (Kepone)

2. Hypervitaminosis A

Question 16

What is a rare cause of IIH?

Answer 16

Amiodarone, Tetracycline

Question 17

If a patient cannot tolerate diamox, what are the next 2 medications to tx IIH?

Answer 17

1. Furosemide (Lasix)

2. Topamax

Question 18

What is a contraindication for diamox use? What pregnancy category is it?

Answer 18

1. Renal disease

2. Preg Category C

Question 19

The IIH treatment trial proved what 2 things?

Answer 19

1. Acetazolamide effect was independent of weight loss
2. VF approved w/ diamox, not VA
3. Diamox is best tx approach