Papilloedema Flashcards
What is papilloedema?
Swelling of optic disc caused by raised ICP
Is papilloedema always bilateral?
Yes but not always symmetrical
How does patient present?
Symptoms of raised ICP:
Nausea and vomiting
Headaches worse in the mornings, frontal region, aggravated by bending down and coughing or sneezing
Visual obscurations - blurring, reduced peripheral vision in late stage
Depression of conscious level
CN6 palsy - runs close to base of skull
Why are headaches associated with raised ICP worse in morning?
Result of hypoventilation during sleeping hours
What can cause papilloedema?
Space occupying lesion Malignant hypertension Hydrocephalus Hypercapnia Idiopathic intracranial hypertension
Rare causes: hypoparathyroidism, hypocalcaemia, vit A toxicity
What features may be observed during fundoscopy?
Venous engorgement - usually first sign Loss of venous pulsation Blurring of optic disc margin Elevation of optic disc Loss of optic cup In places retinal vessels concealed because oedema has impaired translucency of disc Haemorrhages Paton’s lines - concentric/ radial retinal lines cascading from optic disc
What investigations should be done?
Rule out SOL via MRI with gadolium contrast, CT head might be quicker
BP
If no risk of coning consider LP
What is pseudopapilloedema?
May mimic papilloedema
Disc margins blurred and disc appears elevated
Usually benign and associated with hypermetropia +/- astigmatism or tilted discs
No true oedema and veins of normal size and pulsate
Usually bilateral and symmetrical, does not change over time
Treat as papilloedema until otherwise proven
Fluorescence angiography and US can be used to distinguish
Examining the optic disc should aim to describe the..
Contour - boarders should be well defined, may appear oval in astigmatic eyes, abnormally large in myopic
Colour- pink/yellow with pale centre
Cup - should occupy 1/3 of disc (widening and deepening occurs in glaucoma)
