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Survey of Ophthalmology 2022Papilledema is optic nerve head edema secondary to raised intracranial pressure (ICP). It is distinct from other causes of optic disk edema in that visual function is... (Review)
Review
Papilledema is optic nerve head edema secondary to raised intracranial pressure (ICP). It is distinct from other causes of optic disk edema in that visual function is usually normal in the acute phase. Papilledema is caused by transmission of elevated ICP to the subarachnoid space surrounding the optic nerve that hinders axoplasmic transport within ganglion cell axons. There is ongoing controversy as to whether axoplasmic flow stasis is produced by physical compression of axons or microvascular ischemia. The most common cause of papilledema, especially in patients under the age of 50, is idiopathic intracranial hypertension (IIH); however, conditions that decrease cerebrospinal fluid (CSF) outflow by either causing CSF derangements or mechanically blocking CSF outflow channels, and rarely conditions that increase CSF production, can be the culprit. When papilledema is suspected clinically, blood pressure should be measured, and pseudopapilledema should be ruled out. Magnetic resonance imaging of the brain and orbits with venography sequences is the preferred neuroimaging modality that should be performed next to look for indirect imaging signs of increased ICP and to rule out nonidiopathic causes. Lumbar puncture with measurement of opening pressure and evaluation of CSF composition should then be performed. In patients not in a typical demographic group for IIH, further investigations should be conducted to assess for underlying causes of increased ICP. Magnetic resonance imaging of the neck and spine, magnetic resonance angiography of the brain, computed tomography of the chest, complete blood count, and creatinine testing should be able to identify most secondary causes of intracranial hypertension. Treatment for patients with papilledema should be targeted toward the underlying etiology. Most patients with IIH respond to weight loss and oral acetazolamide. For patients with decreased central acuity and constricted visual fields at presentation, as well as patients who do not respond to treatment with acetazolamide, surgical treatments should be considered, with ventriculoperitoneal shunting being the typical procedure of choice.
Topics: Acetazolamide; Humans; Intracranial Hypertension; Optic Nerve Diseases; Papilledema; Pseudotumor Cerebri
PubMed: 34813854
DOI: 10.1016/j.survophthal.2021.11.007 -
International Ophthalmology Clinics 2019
Review
Topics: Humans; Intracranial Hypertension; Intracranial Pressure; Optic Disk; Papilledema
PubMed: 31233413
DOI: 10.1097/IIO.0000000000000274 -
Vestnik Oftalmologii 2022Papilledema (choked disk) is a sign of intracranial hypertension (ICH) - condition that presents danger not only for patient's vision, but also for their life. Despite... (Review)
Review
Papilledema (choked disk) is a sign of intracranial hypertension (ICH) - condition that presents danger not only for patient's vision, but also for their life. Despite the fact that ICH is usually a neurosurgical pathology, sometimes an ophthalmologist is the first doctor such patients visit, most often in a primary healthcare clinic. At the same time, as practice shows, not all ophthalmologists are well aware about in this pathology; difficulties occur in differential diagnosis of papilledema against similar changes of the optic nerve head seen during ophthalmoscopic examination. This article reviews scientific literature on ICH, including benign ICH, diagnosis and differential diagnosis of papilledema. The authors also share their decades-long experience of working in a neurosurgical facility.
Topics: Diagnosis, Differential; Humans; Intracranial Hypertension; Ophthalmoscopy; Optic Disk; Papilledema
PubMed: 36004596
DOI: 10.17116/oftalma202213804187 -
Experimental Eye Research 1977
Review
Topics: Humans; Intracranial Pressure; Intraocular Pressure; Ophthalmoscopy; Optic Nerve; Optic Nerve Diseases; Papilledema; Retinal Vessels; Vision Disorders
PubMed: 338324
DOI: 10.1016/s0014-4835(77)80039-0 -
Ophthalmology Feb 2023
Topics: Humans; Vocabulary; Papilledema
PubMed: 36681466
DOI: 10.1016/j.ophtha.2022.12.009 -
JAMA Ophthalmology May 2022
Topics: Adolescent; Anemia; Humans; Leukopenia; Papilledema
PubMed: 35238881
DOI: 10.1001/jamaophthalmol.2021.5310 -
International Ophthalmology Clinics 2018
Review
Topics: Algorithms; Child; Delivery of Health Care; Humans; Intracranial Hypertension; Papilledema
PubMed: 30239361
DOI: 10.1097/IIO.0000000000000242 -
Current Neurology and Neuroscience... Jun 2012Papilledema is a term generally reserved (at least in the English language use of the term) by neuro-ophthalmologists for optic disc edema due to increased intracranial... (Review)
Review
Papilledema is a term generally reserved (at least in the English language use of the term) by neuro-ophthalmologists for optic disc edema due to increased intracranial pressure. The etiology for the intracranial hypertension may be known (e.g., brain tumor, meningitis, cerebral venous sinus thrombosis) or may be idiopathic (idiopathic intracranial hypertension [IIH]). IIH is a disorder that predominantly affects overweight women of childbearing age and these epidemiologic factors should offer clues to pathogenesis. The main morbidity of papilledema is visual loss and the major mechanism for permanent optic nerve damage is axoplasmic flow stasis and resultant intraneuronal ischemia. The current initial management of papilledema in IIH includes weight loss and medical therapy (e.g., acetazolamide or furosemide). Patients who fail, are intolerant to, or noncompliant with maximum tolerated medical therapy might require optic nerve sheath fenestration or cerebrospinal fluid diversion (i.e., shunting) procedures.
Topics: Humans; Intracranial Hypertension; Papilledema; Vision Disorders
PubMed: 22354546
DOI: 10.1007/s11910-012-0257-8 -
American Family Physician Mar 1992The term "papilledema" describes optic disc swelling resulting from increased intracranial pressure. A complete history and direct funduscopic examination of the optic... (Review)
Review
The term "papilledema" describes optic disc swelling resulting from increased intracranial pressure. A complete history and direct funduscopic examination of the optic nerve head and adjacent vessels are necessary to differentiate papilledema from optic disc swelling due to other conditions. Signs of optic disc swelling include elevation and blurring of the disc and its margins, venous congestion, and retinal hard exudates, splinter hemorrhages and infarcts. Patients with papilledema usually present with signs or symptoms of elevated intracranial pressure, such as headache, nausea, vomiting, diplopia, ataxia or altered consciousness. Causes of papilledema include intracranial tumors, idiopathic intracranial hypertension (pseudotumor cerebri), subarachnoid hemorrhage, subdural hematoma and intracranial inflammation. Optic disc edema may also occur from many conditions other than papilledema, including central retinal artery or vein occlusion, congenital structural anomalies and optic neuritis.
Topics: Diagnosis, Differential; Humans; Optic Nerve; Papilledema
PubMed: 1543098
DOI: No ID Found -
Journal of Neuro-ophthalmology : the... Dec 2022
Topics: Humans; Papilledema; Ophthalmoplegia
PubMed: 36255092
DOI: 10.1097/WNO.0000000000001707