Papilledema physical examination: Difference between revisions

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{{Papilledema}}
{{Papilledema}}
{{CMG}}; '''Associate Editor(s)-In-Chief: '''Kalsang Dolma, MBBS
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==Overview==
==Overview==
The signs of [[papilledema]] include blurring of the margins of the optic disc, edema, and hemorrhages on [[fundoscopy]].
The signs of [[papilledema]] include blurring of the margins of the optic disc, edema, and hemorrhages on [[fundoscopy]].


==Physical Examination==
==Physical Examination==
'''Vital signs''': look for [[blood pressure]] to rule out [[hypertension]]
===Vitals===
 
Look for [[blood pressure]] to rule out [[hypertension]]
'''Eyes 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]  
[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]
 
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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.
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.


There are 10 hallmarks of '''papilledema''' seen by using '''opthalmoscope''':
There are 10 hallmarks of papilledema seen by using [[opthalmoscope]]:
* Blurring of the [[disc margins]]
* Blurring of the [[disc margins]]
* Filling in of the [[optic disc cup]]
* Filling in of the [[optic disc cup]]
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* Hard exudates of the [[optic disc]]
* Hard exudates of the [[optic disc]]


'''Frisén''' has proposed a useful staging scheme for papilledema with good sensitivity and specificity based on the '''ophthalmoscopic''' signs of disturbed axoplasmic transport.It has been modified recently with a key finding added for each stage or grade.
Frisén has proposed a useful staging scheme for papilledema with good sensitivity and specificity based on the ophthalmoscopic signs of disturbed axoplasmic transport. It has been modified recently with a key finding added for each stage or grade.


* Grade 0 Represents a normal optic disc.
* Grade 0 Represents a normal optic disc.
   
   
* Grade 1 Presence of a C-shaped or reverse C-shaped halo of peripapillary edema obscuring the retina adjacent to the optic disc. The temporal border of the optic disc is spared presumably due to the fine caliber of these axons .  
* Grade 1 Presence of a C-shaped or reverse C-shaped halo of peripapillary edema obscuring the retina adjacent to the optic disc. The temporal border of the optic disc is spared presumably due to the fine caliber of these axons.  


* Grade 2 The C-shaped halo becomes circumferential with grade 2 papilledema .  
* Grade 2 The C-shaped halo becomes circumferential with grade 2 papilledema.  


* Grade 3 Complete obscuration of at least one major vessel as it leaves the optic disc .  
* Grade 3 Complete obscuration of at least one major vessel as it leaves the optic disc.  


* Grade 4 Complete obscuration of at least one major vessel on the optic disc .  
* Grade 4 Complete obscuration of at least one major vessel on the optic disc.  


* Grade 5 Total obscuration of at least one vessel on the disc and leaving the disc and at least partial obscuration of all major vessels leaving or on the disc.
* Grade 5 Total obscuration of at least one vessel on the disc and leaving the disc and at least partial obscuration of all major vessels leaving or on the disc.
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==References==
==References==
{{Reflist|2}}
{{reflist|2}}
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
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Latest revision as of 17:05, 11 June 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Overview

The signs of papilledema include blurring of the margins of the optic disc, edema, and hemorrhages on fundoscopy.

Physical Examination

Vitals

Look for blood pressure to rule out hypertension

Eyes

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Checking the eyes for signs 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 headaches.

There are 10 hallmarks of papilledema seen by using opthalmoscope:

Frisén has proposed a useful staging scheme for papilledema with good sensitivity and specificity based on the ophthalmoscopic signs of disturbed axoplasmic transport. It has been modified recently with a key finding added for each stage or grade.

  • Grade 0 Represents a normal optic disc.
  • Grade 1 Presence of a C-shaped or reverse C-shaped halo of peripapillary edema obscuring the retina adjacent to the optic disc. The temporal border of the optic disc is spared presumably due to the fine caliber of these axons.
  • Grade 2 The C-shaped halo becomes circumferential with grade 2 papilledema.
  • Grade 3 Complete obscuration of at least one major vessel as it leaves the optic disc.
  • Grade 4 Complete obscuration of at least one major vessel on the optic disc.
  • Grade 5 Total obscuration of at least one vessel on the disc and leaving the disc and at least partial obscuration of all major vessels leaving or on the 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.

References

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