Papillodema

Question 1

What is papillodema?

Answer 1

= Swelling of optic nerve secondary to raised intracranial pressure.
- From a build up of cerebrospinal fluid (CSF)

Question 2

What is the aetiology/cause of papillodema?

Answer 2

• Any intracraniasl mass (tumour, meningitis, hydrocyphalus).
• Pathogenesis: The subrachanoid space is filled abnormally with CSF during papillodema, causing ON to swell and push the ONH formed.
• Idiopathic
• Obese, young women

Question 3

Presentation/Symptoms of Papillodema?

Answer 3

• H/A (mornings/on waking, worse on bending, coughing, sneezing, severe and gets worse over weeks)
• Nausea + vomiting
• Pulsatile tinnitus (ringing in ears)
• V. vision normal, transient. End stage = Reduced VA + VF loss.
• P. pupils, no RAPD until end stage
• C. colour vision not affected until end stage
• D. diplopia (horizontal dip - 6th NP)

Question 4

Signs for early, established, chronic papilledema

Answer 4

Early Stages:

• Normal Vision
• Hyperaemia (an excess of blood to vessels)
• Blurred Margins
• C-shaped halo
• Loss of SVP

Established Stages:

• Transient loss of vision
• VA normal/reduced
• Severe Hyperaemia
• Mod-Pronounced elevation
• Blurred Margins
• ‘Filled in’ optic disc
• Flame Haemorrhages + CWS
• Enlarged blindspots

Chronic Stage:

• Variable VA
• Severe disc elevation
• No Haemorrhages or CWS
• Shunt vessels or crystalline deposits on disc
• END STAGE: optic atrophy

Question 5

Management/Referral for Papilledema

Answer 5

EMERGENCY (SAME DAY)

• MRI to look for tumour
• Lumbar puncture to look at CSF
• Full history + Meds check

Question 6

Differential Diagnosis:

Answer 6

• Optic Neuritis
• AION
• CRVO
• Malignant Hypertension
• Posterior Uveitis