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BMJ (Clinical Research Ed.) Jul 2010
Topics: Adult; Diet, Reducing; Female; Humans; Intracranial Pressure; Papilledema; Prospective Studies; Pseudotumor Cerebri
PubMed: 20610513
DOI: 10.1136/bmj.c2836 -
Journal of Neuro-ophthalmology : the... Jun 2022Optic disc drusen (ODD) are calcified deposits at the anterior optic nerve that are often detectable by ophthalmic imaging, including optical coherence tomography and...
Optic disc drusen (ODD) are calcified deposits at the anterior optic nerve that are often detectable by ophthalmic imaging, including optical coherence tomography and fundus autofluorescence imaging. Multicolor (MC) imaging is a novel modality that captures reflectance of blue, green, and near-infrared laser lights with confocal scanning laser ophthalmoscopy to rapidly acquire high-resolution reflectance images of the optic disc and retina. Here, we show an eye with 3 MC imaging features of ODD, including prominent green hyperreflectance of the optic disc, green sheathing of the papillary and peripapillary vasculature (arterioles > venules), and presence of orange superficial ODD. MC imaging can provide rapid high-resolution assessment of eyes with optic nerve head elevation to help distinguish pseudopapilledema vs papilledema in children and adults without dilation, and future large studies incorporating MC imaging will help determine its contribution in the diagnosis and monitoring of ODD and assessment of other causes of optic nerve head elevation.
Topics: Adult; Child; Humans; Nerve Fibers; Optic Disk Drusen; Optic Nerve Diseases; Papilledema; Retinal Ganglion Cells; Tomography, Optical Coherence
PubMed: 35482433
DOI: 10.1097/WNO.0000000000001470 -
AJNR. American Journal of Neuroradiology May 2013Papilledema, defined as swelling of the optic disc, frequently occurs in the setting of increased ICP and in a variety of medical conditions, including pseudotumor... (Review)
Review
Papilledema, defined as swelling of the optic disc, frequently occurs in the setting of increased ICP and in a variety of medical conditions, including pseudotumor cerebri, sinus thrombosis, intracerebral hemorrhage, frontal lobe neoplasms, and Chiari malformation. Noninvasive imaging of the ON is possible by using MR imaging, with a variety of findings occurring in the setting of papilledema, including flattening of the posterior sclera, protrusion of the optic disc, widening of the ONS, and tortuosity of the ON. Early recognition of papilledema and elevated ICP is of paramount importance for ensuring restoration of vision. Newer advanced MR imaging techniques such as fMRI and DTI may prove useful in the future to assess the potential effects of papilledema on retinal and visual pathway integrity.
Topics: Humans; Intracranial Hypertension; Magnetic Resonance Imaging; Optic Disk; Papilledema; Visual Pathways
PubMed: 22422187
DOI: 10.3174/ajnr.A3022 -
Turkish Journal of Ophthalmology Oct 2023To compare the clinical findings and multimodal imaging of pediatric patients diagnosed with papilledema and pseudopapilledema with those of healthy individuals.
OBJECTIVES
To compare the clinical findings and multimodal imaging of pediatric patients diagnosed with papilledema and pseudopapilledema with those of healthy individuals.
MATERIALS AND METHODS
Ninety children (<18 years of age) referred for suspected papilledema were included in this study. All patients underwent optical coherence tomography (OCT) imaging and were compared with normal control subjects.
RESULTS
Fifty-eight children diagnosed with pseudopapilledema, 32 children with mild-to-moderate papilledema, and 40 controls were evaluated. The average and all quadrants of retinal nerve fiber layer (RNFL) thickness were significantly higher in the papilledema group than in the pseudopapilledema and control groups (p<0.001). Bruch's membrane opening (BMO) measurements were similar in both groups (p>0.05). The average, nasal, and temporal RNFL thicknesses were significantly higher in the pseudopapilledema group compared with the controls (p<0.001). Area under the receiver operating characteristic (ROC) curve showed high diagnostic ability for RNFL thickness in all quadrants to differentiate papilledema from pseudopapilledema (p<0.001). In the pseudopapilledema group, average, temporal, and inferior RNFL thickness and BMO measurements were significantly higher in eyes with optic nerve head drusen (n=28) compared with those without drusen (n=88) (p=0.035, p=0.022, p=0.040 and, p=0.047 respectively).
CONCLUSION
Papilledema and pseudopapilledema show great differences in evaluation, follow-up, and prognosis. Using non-invasive methods such as newly developed OCT techniques in differential diagnosis can relieve patients with pseudopapilledema from the stress and financial burden of expensive, extensive, and invasive procedures.
Topics: Humans; Child; Papilledema; Tomography, Optical Coherence; Optic Disk; Retinal Ganglion Cells
PubMed: 37868142
DOI: 10.4274/tjo.galenos.2023.81504 -
Headache Feb 2009To compare clinical features, visual characteristics, and treatment of idiopathic intracranial hypertension patients with and without papilledema. (Comparative Study)
Comparative Study
OBJECTIVE
To compare clinical features, visual characteristics, and treatment of idiopathic intracranial hypertension patients with and without papilledema.
BACKGROUND
Idiopathic intracranial hypertension does not often occur without papilledema. This study estimates the prevalence and compares the clinical characteristics of idiopathic intracranial hypertension patients with and without papilledema.
METHODS
We performed a cross-sectional analysis of all idiopathic intracranial hypertension patients diagnosed at the University of Utah Neuro-Ophthalmology Unit between 1990 and 2003. Patient records were reviewed for presence of papilledema and other signs, symptoms, and treatment characteristics. Each patient without papilledema was matched to the patient with papilledema who was closest to his/her age and sex. McNemar's and Wilcoxon-signed rank sum tests were used to compare characteristics between matched pairs.
RESULTS
Among all patients (n = 353), the prevalence of those without papilledema was 5.7% (n = 20). Patients without papilledema reported photopsias (20%), and were found to have spontaneous venous pulsations (75%) and non-physiologic visual field constriction (20%) more often than did those with papilledema. Mean opening pressure, although above normal, was lower in patients without papilledema (mean = 309 mm cerebrospinal fluid) compared with those with papilledema (mean = 373 mm cerebrospinal fluid, P = .031). Idiopathic intracranial hypertension patients without papilledema had more frequent diagnostic lumbar punctures than did patients with papilledema. Visual acuities and treatment were similar between groups.
CONCLUSIONS
The clinical presentation of idiopathic intracranial hypertension without papilledema is only somewhat different from that of idiopathic intracranial hypertension with papilledema. The lower opening pressure in patients without papilledema may explain variations in symptoms and signs between the 2 groups. When there are visual field changes in idiopathic intracranial hypertension without papilledema, non-physiologic visual loss should be considered.
Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Papilledema; Pseudotumor Cerebri; Vision Disorders
PubMed: 19222592
DOI: 10.1111/j.1526-4610.2008.01324.x -
Investigative Ophthalmology & Visual... Sep 2015To determine the frequency, patterns, associations, and biomechanical implications of retinal and choroidal folds in papilledema due to idiopathic intracranial...
PURPOSE
To determine the frequency, patterns, associations, and biomechanical implications of retinal and choroidal folds in papilledema due to idiopathic intracranial hypertension (IIH).
METHODS
Retinal and choroidal folds were studied in patients enrolled in the IIH Treatment Trial using fundus photography (n = 165 study eyes) and spectral-domain optical coherence tomography (SD-OCT; n = 125). We examined the association between folds and peripapillary shape, retinal nerve fiber layer (RNFL) thickness, disc volume, Frisén grade, acuity, perimetric mean deviation, intraocular pressure, intracranial pressure, and refractive error.
RESULTS
We identified three types of folds in IIH patients with papilledema: peripapillary wrinkles (PPW), retinal folds (RF), and choroidal folds (CF). Frequency, with photos, was 26%, 19%, and 1%, respectively; SD-OCT frequency was 46%, 47%, and 10%. At least one type of fold was present in 41% of patients with photos and 73% with SD-OCT. Spectral-domain OCT was more sensitive. Structural parameters related to the severity of papilledema were associated with PPW and RF, whereas anterior deformation of the peripapillary RPE/basement membrane layer was associated with CF and RF. Folds were not associated with vision loss at baseline.
CONCLUSIONS
Folds in papilledema are biomechanical signs of stress/strain on the optic nerve head and load-bearing structures induced by intracranial hypertension. Folds are best imaged with SD-OCT. The patterns of retinal and choroidal folds are the products of a complex interplay between the degree of papilledema and anterior deformation of the load-bearing structures (sclera and possibly the lamina cribrosa), both modulated by structural geometry and material properties of the optic nerve head. (ClinicalTrials.gov number, NCT01003639.).
Topics: Adult; Aged; Biomechanical Phenomena; Choroid; Female; Humans; Intracranial Hypertension; Intracranial Pressure; Intraocular Pressure; Male; Middle Aged; Nerve Fibers; Optic Disk; Papilledema; Refractive Errors; Retina; Tomography, Optical Coherence; Visual Acuity
PubMed: 26335066
DOI: 10.1167/iovs.15-17459 -
Romanian Journal of Ophthalmology 2019We present a case of a 47-year-old female patient, with papillitis in the right eye and anterior uveitis in both eyes, as a manifestation of untreated neurosyphilis.
We present a case of a 47-year-old female patient, with papillitis in the right eye and anterior uveitis in both eyes, as a manifestation of untreated neurosyphilis.
Topics: Diagnosis, Differential; Eye Infections, Bacterial; Female; Humans; Middle Aged; Neurosyphilis; Optic Disk; Papilledema; Slit Lamp Microscopy; Uveitis, Anterior; Visual Acuity; Visual Field Tests; Visual Fields
PubMed: 31915744
DOI: No ID Found -
Ugeskrift For Laeger May 2014Optic disc oedema describes the nonspecific, localized swelling of the optic nerve head regardless of aetiology. Therefore, differentiating among the various aetiologies... (Review)
Review
Optic disc oedema describes the nonspecific, localized swelling of the optic nerve head regardless of aetiology. Therefore, differentiating among the various aetiologies depends on a thorough history and knowledge of the clinical characteristics of the underlying conditions. Papilloedema strictly refers to optic disc oedema as a consequence of elevated intracranial pressure. It is usually a bilateral condition and visual function is preserved until late. Optic disc oedema caused by an anterior optic neuropathy is usually unilateral and accompanied by the loss of visual function.
Topics: Algorithms; Humans; Intracranial Hypertension; Optic Nerve Diseases; Papilledema
PubMed: 25351900
DOI: No ID Found -
Neurology India 2019Over the last decade, the National Aeronautics and Space Administration's (NASA) Space Medicine Division has documented a variety of unusual physiological and... (Review)
Review
Over the last decade, the National Aeronautics and Space Administration's (NASA) Space Medicine Division has documented a variety of unusual physiological and pathological neuro-ophthalmic findings in astronauts during and following long duration space flight. These ndings include optic disc swelling, globe flattening, choroidal folds, and hyperopic shifts in refraction. Cephalad fluid shift has been proposed as a possible unifying etiology, but the specific mechanism responsible for these changes remains obscure. This manuscript reviews the history, clinical findings, and potential neurophysiological etiologies for spaceflight-associated neuro-ocular syndrome.
Topics: Astronauts; Extraterrestrial Environment; Humans; Intracranial Pressure; Papilledema; Space Flight; Syndrome; Vision Disorders
PubMed: 31134911
DOI: 10.4103/0028-3886.259126 -
Journal of Clinical Research in... Jun 2021To investigate the incidence of pseudotumor cerebri syndrome (PTCS) in children treated with growth hormone (GH) in a paediatric hospital and to identify risk factors...
OBJECTIVE
To investigate the incidence of pseudotumor cerebri syndrome (PTCS) in children treated with growth hormone (GH) in a paediatric hospital and to identify risk factors for this complication.
METHODS
Prospective pilot study of paediatric patients treated with recombinant human GH, prescribed by the Paediatric Endocrinology Department, between February 2013 and September 2017. In all these patients, a fundus examination was performed before starting treatment and 3-4 months later.
RESULTS
Two hundred and eighty-nine patients were included, of whom 244 (84.4%) had GH deficiency, 36 (12.5%) had short stature associated with small for gestational age, six (2.1%) had a mutation in the gene and three (1.0%) had Prader-Willi syndrome. Five (1.7%) developed papilledema, all were asymptomatic and had GH deficiency due to craniopharyngioma (n=1), polymalformative syndrome associated with hypothalamic-pituitary axis anomalies (n=2), a non-specified genetic disease with hippocampal inversion (n=1) and one with normal magnetic resonance imaging who had developed a primary PTCS years before.
CONCLUSION
GH treatment is a cause of PTCS. In our series, at risk patients had GH deficiency and hypothalamic-pituitary anatomic anomalies or genetic or chromosomal diseases. Fundus examination should be systematically screened in all patients in this at-risk group, irrespective of the presence or not of symptoms.
Topics: Adolescent; Child; Child, Preschool; Female; Hormone Replacement Therapy; Human Growth Hormone; Humans; Infant; Male; Papilledema; Pilot Projects; Prospective Studies; Pseudotumor Cerebri; Recombinant Proteins; Risk Factors
PubMed: 33006547
DOI: 10.4274/jcrpe.galenos.2020.2020.0007