Papilloedema

Question 1

Define the slight difference between optic disc swelling in general and papilloedema ?

Answer 1

• Swollen disc means disc swelling secondary to ANY cause
• Papilloedema refers to swollen optic discs due to raised ICP

Question 2

What should be suspected in all patients with bilateral optic disc swelling until proven otherwise ?

Answer 2

• Raised ICP due to a space occupying lesion (SOL)
• This is a med emergency

Question 3

How does the optic discs become swollen due to raised ICP?

Answer 3

• Raised ICP is transmitted onto the Subarachnoid space (SAS) around optic nerve (ON)
• This causes interruption of axoplasmic flow and venous congestion= swollen discs

Question 4

What are the 3 components which together make up ICP

Answer 4

1. Brain (80%)
2. Blood (10%)
3. CSF (10%)

Question 5

What can happen if there is raised ICP ?

Answer 5

• The brain can be squeezed out of the foramen magnum as rest of the skull is solid and doesn’t vary in size
• This can then result in death

Question 6

How does malignant hypertension result in disc swelling/rasied ICP?

Answer 6

• Failure of autoregulation of blood supply to the brain
• Resulting in ischaemia and swelling

Question 7

What are the causes of raised ICP in-relation to CSF?

Answer 7

• Obstruction to CSF circulation
• Overproduction of CSF
• Inadequate absorption

Question 8

What investigations should be done to find the cause of raised ICP ?

Answer 8

• Ophthalmoscope to first off see the disc swelling
• Scan of the head
• Check BP
• And lumbar puncture to check CSF

Question 9

What are the potential complications of chronic disc swelling ?

Answer 9

Loss of visual function occurs and blindness may result.

Question 10

What are the causes of papilloedema ?

Answer 10

• space-occupying lesion: neoplastic, vascular
• malignant hypertension
• idiopathic intracranial hypertension
• hydrocephalus
• hypercapnia

Question 11

What are the features of papilloedema seen on fundoscopy ?

Answer 11

• venous engorgement: usually the first sign
• loss of venous pulsation: although many normal patients do not have normal pulsation
• blurring of the optic disc margin
• elevation of optic disc
• loss of the optic cup
• Paton’s lines: concentric/radial retinal lines cascading from the optic disc