Papilloedema

Question 1

Define papilloedema

What are the clinical features?

Answer 1

Swollen optic disc secondary to raised intracranial pressure

Question 2

What are the clinical features of papilloedema?

Answer 2

Enlarged blind spot
Blurring of vision
Visual obscurations
Visual loss
Blindness

Question 3

What must be ruled out in patients with bilateral swollen optic discs?

Answer 3

Raised intracranial pressure due to space-occupying lesion

Question 4

What does an examination of cranial nerve II comprise of?

Answer 4

Ophthalmoscopy
Visual acuity
Visual field assessment
Pupillary response
Colour vision

Question 5

What is the pathophysiology behind true papilloedema?

Answer 5

Subarachnoid space surrounding brain is continuous with subarachnoid space surrounding optic nerve
When ICP increases, this is transmitted to the nerve, causing swollen discs

Question 6

What 3 components contribute to intracranial pressure?

Answer 6

Brain
CSF
Blood

Question 7

How does a patient die from raised ICP as a result of increased brain size?

Answer 7

Brain squeezes through foramen magnum and compresses brainstem, inhibiting respiratory centre - patient can’t breathe and dies

Question 8

The brain is very tolerant of hypo/hyper -perfusion. True/False?

Answer 8

False

Needs constant blood supply over range of pressures

Question 9

What factors relating to CSF contribute to raised ICP?

Answer 9

Obstruction to CSF circulation
Overproduction of CSF
Inadequate absorption of CSF

Question 10

If a CT is normal following suspected raised ICP, what is done?

Answer 10

Lumbar puncture to assess CSF

Question 11

What is the term used to describe increased CSF in the ventricular system?

Answer 11

Hydrocephalus

Question 12

What are the features of idiopathic intracranial hypertension?

Answer 12

Hypertension
Headaches
Visual disturbances
Typically, obesity

Question 13

How is idiopathic intracranial hypertension managed?

Answer 13

Weight loss
Acetazolamide
Lumbar puncture

Question 14

What is glaucoma? How is it treated?

Answer 14

Increased introcular pressure due to imbalance between secretion and removal of aqueous humour
Carbonic anhydrase inhibitors e.g. dorzolamide, acetazolamide.

Question 15

List the meninges in order from the immediate covering of the optic nerve

Answer 15

1. Pia
   (Subarachnoid space)
2. Arachnoid matter
3. Dura

Question 16

What is papilloedema commonly mistaken for?

Answer 16

Cupping - progressive thinning of the neuroretinal rim causing an increase in cup size

Question 17

What clinical features would you expect from paralysis of the oculomotor nerve?

Answer 17

Slowing of pupillary light reflex
DIlated pupil
Ptosis
‘Down and out’ pupil

Question 18

What clinical features would you expect from paralysis of the trochlear nerve?

Answer 18

Diplopia when looking down

Can’t intort causing inopposed extorsion and head tilt to affected side

Question 19

What clinical features would you expect from paralysis of the abducent nerve?

Answer 19

Medial deviation of the eye (eye cant ABD)

Question 20

Describe the tentorial herniation causing compression of CNIII

Answer 20

Medial temporal lobe herniates through tentorial notch