Papilledema
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Papilledema | |
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Fundal photograph showing severe papilledema in the left eye | |
Specialty | Ophthalmology, optometry, neuro-ophthalmology, neurology, neurosurgery |
Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause.[1] The swelling is usually bilateral and can occur over a period of hours to weeks.[2] Unilateral presentation is extremely rare.
In intracranial hypertension, the optic disc swelling most commonly occurs bilaterally. When papilledema is found on
Signs and symptoms
Despite being classically referred to as a key symptom of rising intracranial pressure, papilledema is often not present in patients seen in an acute setting such as an emergency room. Many urgent cases of increased ICP only have identifiable papilledema after a day or more.[1]
Early on, papilledema may be discovered on examination with an ophthalmoscope without any changes in patient vision. It can progress to enlargement of the blind spot, blurring of vision, a concentric blind spot pattern, or diplopia (double vision). Ultimately, total loss of vision can occur, as well as other patterns of permanent injury to the optic nerve.[1]
The signs of papilledema that may be seen using an
- venous engorgement (usually the first signs)
- loss of venous pulsation
- hemorrhages over and/or adjacent to the optic disc
- blurring of optic margins
- elevation of the optic disc
- Paton's lines (radial retinal lines cascading from the optic disc)
On visual field examination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged.
Causes
Raised intracranial pressure[1] as a result of one or more of the following:
- intracerebral hemorrhage
- Respiratory failure[4]
- Isotretinoin, which is a powerful derivative of vitamin A, rarely causes papilledema.
- medications like tetracycline
- Hypervitaminosis A, in some people who take megadoses of nutritional supplements and vitamins.
- Hyperammonemia, elevated level of ammonia in blood (including cerebral edema/intracranial pressure)
- Guillain–Barré syndrome, due to elevated protein levels
- paraneoplasticsyndrome that can cause increased intracranial pressure.
- Foster Kennedy syndrome (FKS)
- Chiari malformation
- Tumors of the frontal lobe
- Acute mountain sickness and high-altitude cerebral edema
- Meningitis, leading to increased crainial pressure[5]
- Intracranial hypertension[6]
- Malignant hypertension
- Medulloblastoma
- Obesity[7]
- Orbital
- Acute lymphocytic leukemia(caused by infiltration of the retinal vessels by immature leukocytes)
- Long periods of visual impairment and intracranial pressure)
- CPAP therapy for sleep apnea: Those with sleep apnea on continuous positive airway pressure therapy had a 105% increased hazard of experiencing papilledema (adjusted HR=2.05 [CI=1.19-3.56])[further explanation needed] relative to individuals without sleep apnea.[9]
Pathophysiology
As the
Diagnosis
Checking the
It is important to determine whether the observed condition is due to
Treatment
Historically, papilledema was a potential
The treatment depends largely on the underlying cause. However, the root cause of papilledema is the
Thus, a biopsy is routinely performed prior to the treatment in the initial stages of papilledema to detect whether a brain tumor is present. If detected, laser treatment, radiation and surgeries can be used to treat the tumor.
To decrease ICP, medications can be administered by increasing the absorption of
Meanwhile,
Other treatments include repeated lumbar punctures to remove excess spinal fluid in the cranium. The removal of potentially causative medicines including
References
- ^ ISBN 978-1-60535-962-5.
- )
- S2CID 25301791.
- PMID 18169104.
- .
- .
- S2CID 6759222.
- ^ Rich Phillips (2012-02-10). "Astronaut feels space's toll on his body". CNN. Retrieved 2012-03-01.
- PMID 21851924.
- PMID 3655817.