View source for Papilledema

{{Infobox_Disease |
  Name           = Papilledema  |
  Image          = Papilledema 1.jpg|
  Caption        = Papilledema. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|
  DiseasesDB     = 9580 |
  ICD10          = {{ICD10|H|47|1|h|46}} |
  ICD9           = {{ICD9|377.0}}  |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID         = D010211 |
}}
{{Search infobox}}
{{CMG}}; '''Associate Editor-In-Chief:'''  Kalsang Dolma, M.D.

== Overview ==
'''Papilledema''' (or '''papilloedema''') is [[optic disc]] swelling that is caused by increased [[intracranial pressure]]. The swelling is usually bilateral and can occur over a period of hours to weeks. Papilledema occurs in approximately 50% of those with a [[brain tumour]].

==Pathophysiology==
As the [[optic nerve]] sheath is continuous with the [[subarachnoid space]] of the [[brain]] (and is regarded as an extension of the [[central nervous system]]), increased pressure is transmitted through to the optic nerve.  The brain itself is relatively spared from pathological consequences of high pressure.  

However, the anterior end of the optic nerve stops abruptly at the eye. Hence the pressure is asymmetrical and this causes a pinching and protrusion of the optic nerve at its head.  

The fibers of the [[Ganglion cell|retinal ganglion cell]]s of the optic disc become engorged and bulge anteriorly.  Persistent and extensive optic nerve head swelling, or optic disc edema, can lead to loss of these fibers and permanent visual impairment.

==Differential diagnosis of causes of papilledema==

==Most common==




==Organ system based==

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Hypertension]], [[Hypertensive encephalopathy]], [[Hypertensive retinopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Methanol]], [[Ethylene glycol]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Cisplatin]], [[Corticosteroid]], [[Growth hormone treatment]], [[Insulin-like growth factor 1]], [[Interleukin 11]], [[Isotretinoin]], [[Lithium]], [[Minocycline]], [[Tetracycline]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Cushing's disease]], [[Diabetic retinopathy]], [[Thyroid opthalmopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Acute liver failure]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Camurati - Engelmann disease]], [[Crouzon syndrome]], [[Fabry's Disease]], [[Tuberous sclerosis]], [[Vogt-Koyanagi-Harada syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Brucellosis]], [[Epidural abscess]], [[Infective endocarditis]], [[Meningitis]], [[Meningoencephalitis]], [[Paragonimiasis]], [[Syphillis]], [[Toxoplasmosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Paget's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Cavernous Sinus Thrombosis]], [[Arachnoid cyst]], [[Arnold chiari malformation]], [[Brain Abscess]], [[Brain cyst]], [[Brown - symmers disease]], [[Cerebellar abscess]],
[[Cerebral abscess]], [[Cerebral venous sinus thrombosis]], [[Dandy-Walker syndrome]], [[Epidural hematoma]], [[Foster kennedy syndrome]], [[Intracranial bleeding]]
[[Medulloblastoma]], [[Myoclonic epilepsy]], [[Parinaud's syndrome]], [[Subarachnoid hemmorhage]], [[Subdural empyema]], [[Subdural hematoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Nutritional optic neuropathy]]

|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Eclampsia]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Adult low grade infiltrative suoratentorial astrocytoma]], [[Brain Stem Gliomas]], [[Brain tumor]], [[Chondroma]], [[Choroid plexus neoplasm]], [[Malignant Astrocytomas]], [[Neuroectodermal tumor primitive]], [[Osteoma]], [[Tumor lysis syndrome]] 
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Amaurosis fugax]], [[Chorioretinitis]], [[Glaucoma]], [[Neuropapillitis]], [[Optic disc drusen]], [[Optic disc vasculitis]], [[Optic neuritis]], [[Orbital lesion]], [[Orbital optic nerve tumors]], [[Papillitis]], [[Retinal vein occlusion]], [[Scleritis]], [[Age related macular degeneration]], [[Anterior ischemic optic neuropathy]], [[Central retinal vein occlusion]],
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Arsenical]], [[Carbon monoxide toxity]], [[Ethylene glycol]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Hypercapnea]], [[Obesity hypoventilation syndrome]], [[Respiratory acidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Acid base imbalance]], [[Hypocalcemic encephalopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Sarcoidosis]], [[Sympathetic ophthalmia]], [[Systemic Lupus Erythematoses]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Head trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Idiopathic increase inratcranial tension]], [[POEMS syndrome]], [[Deafness- peripheral- neuropathy- arterial disease]]
|-
|}

==In alphabetical order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>==

*[[Arachnoid cyst]]
*[[Arnold chiari malformation]]
*Atypical [[optic neuritis]]
*[[Brain cyst]]
*[[Brain tumor]]
*[[Cavernous sinus thrombosis]]
*[[Central retinal vein occlusion]]
*[[Cerebral abscess]]
*[[Chondroma]]
*[[Cisplatin]]
*[[Corticosteroids]]
*[[Crouzon's disease]]
*[[Cushing's syndrome]]
*[[Diabetic]] papillopathy
*[[Eclampsia]]
*[[Epidural hematoma]]
*Extradural [[abscess]]
*Foster Kennedy's syndrome
*[[Grave's opthalmopathy]]
*[[Head trauma]]
*[[Hypercapnia]]
*[[Hyperparathyroidism]]
*Hypertensive [[encephalopathy]]
*[[Hypocalcemic tetany]]
*Idiopathic [[intracranial hypertension]]
*[[Intracranial hemorrhage]]
*Infectious [[endocarditis]]
*[[Lithium]]
*[[Hydrocephalus]]
*[[Malignant hypertension]]
*[[Meningitis]]
*[[Meningoencephalitis]]
*Neuropappilitis
*[[Optic disc]] [[vasculitis]]
*Orbital lesions
*Orbital [[optic nerve]] tumors
*[[Osteoma]]
*[[Paget's disease]]
*Papillitis
*Psuedopapilledema
*[[Sarcoidosis]]
*[[Subarachnoid hemorrhage]]
*[[Subdural empyema]]
*[[Subdural hematoma]]
*[[Syphillis]]
*[[Systemic lupus erythematosus]]
*[[Tetracyclines]]
*[[Thyrotoxicosis]]
*[[Uveitis]]

==Diagnosis==

Checking the [[eye]]s for [[sign (medicine)|sign]]s of papilledema should be carried out whenever there is a clinical suspicion of raised [[intracranial pressure]]. Because of the (rare) possibility of a [[brain tumor]], ''[[pseudotumor cerebri]]'' or [[cerebral venous sinus thrombosis]], all of which can increase intracranial pressure, this examination has become common for patients suffering from [[headache]]s.

=== Physical Examination ===

==== Eyes ====
[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] 

<div align="left">
<gallery heights="175" widths="175">
Image:Papilledema 1.jpg|Papilledema.
Image:Pseudopapilledema.jpg|Pseudopapilledema. 
</gallery>

There are 10 hallmarks of '''papilledema''':
*Blurring of the [[disc margins]]
*Filling in of the [[optic disc cup]]
*Anterior bulging of the [[nerve head]]
*Edema of the nerve fiber layer
*Retinal or [[choroidal]] folds
*Congestion of [[retinal veins]]
*Peripapillary [[hemorrhages]]
*Hyperemia of the optic nerve head
*Nerve fiber layer infarcts
*Hard exudates of the [[optic disc]]

==References==
{{Reflist|2}}

{{Eye pathology}}

[[de:Stauungspapille]]
[[it:Papilledema]]

[[Category:Neurology]]
[[Category:Signs and symptoms]]
[[Category:Emergency medicine]]

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