week 2 papilloedema

Question 1

what is papilloedema

Answer 1

specific term meaning swollen optic discs secondary to raised intracranial pressure (ICP)

Question 2

how does papilloedema differ to Swollen optic discs?

Answer 2

• Swollen optic discs’ means disc swelling secondary to ANY cause
• papilloedma specific to raised ICP

Question 3

what should all patient with bilateral optic disc swelling be suspected of?

Answer 3

raised ICP due to space occupying lesion (SOL) until proven otherwise

Question 4

is raised ICP a medical emergency

Answer 4

yes

Question 5

what is an ophthalmoscopy?

Answer 5

fundoscopy

Question 6

what does CN2 exam involve?

Answer 6

visual acuity 
pupil exam
visual field assessment
colour vision
Ophthalmoscopy (examine optic discs)

Question 7

what three things determine ICP

Answer 7

brain
blood
CSF

Question 8

60 y/o male, blurred vision, headaches for year. VA 6/6 R+L. bilateral optic disc swelling on exam

Answer 8

brain tumour

Question 9

why does raised ICP cause papilloedema

Answer 9

Subarachnoid space (SAS) around optic nerve (ON) continuous with subarachnoid space surrounding the brain

When intracranial pressure increases, this is transmitted to the SAS then to the ON…..

This causes interruption of axoplasmic flow and venous congestion= swollen discs

Question 10

why is raised ICP an emergency?

Answer 10

Cranial vault is rigid therefore cannot expand with increasing ICP

Opening in base of skull known
as foramen magnum

With raised ICP, brain is squeezed through foramen magnum, brainstem compressed, patient stops breathing and dies

Question 11

55 year old male
Smoker, overweight
c/o blurred vision for 1 week
Went to optician for eye check.... - bilateral papilloedema on fundoscopy
BP=240/140

Answer 11

malignant hypertension

Question 12

what to do in patient with disc swelling?

Answer 12

MRI brain (brain)
BP check (blood)
lumbar puncture (CSF)

Question 13

functions of CSF

Answer 13

Maintains stable extracellular environment for the brain

Buoyancy

Provides mechanical protection

Waste removal

Nutrition

Question 14

where is CSF produced? where does it travel?

Answer 14

Most produced in lateral ventricles by choroid plexus*

CSF travels through 3rd and 4th ventricles into subarachnoid space

*Choroid plexus is network of capillaries which filter blood to form CSF

Question 15

when will ICP inc due to CSF?

Answer 15

Obstruction to CSF circulation
Overproduction of CSF
Inadequate absorption

Question 16

25 year old female

6 month history headaches

BMI 40

VA 6/6 R & L

Answer 16

Idiopathic Intracranial Hypertension (IIH)

raised ICP on lumbar puncture

Question 17

what happens if optic disc swelling (due to any cause) becomes chronic?

Answer 17

Disc swelling subsides, discs become atrophic and pale.

Loss of visual function occurs and blindness may result.