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| ==[[Papilledema overview|Overview]]== | | ==[[Papilledema overview|Overview]]== |
| Papilledema is defined as swelling of the [[optic disc]] that is caused by increased [[intracranial pressure]]. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare. Papilledema is mostly seen as a symptom resulting from another pathophysiological process.
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| In intracranial hypertension, papilledema most commonly occurs bilaterally. When papilledema is found on fundoscopy, further evaluation is warranted as vision loss can result if the underlying condition is not treated. Further evaluation with a CT or MRI of the brain and/or spine is usually performed. Unilateral papilledema can suggest orbital pathology, such as an optic nerve glioma. Treatment largely depends on underlying cause. However the root cause of papilledema is increase intracranial pressure. To decrease intracranial pressure, medical and surgical interventions can be administered.
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| ==Pathophysiology== | | ==Pathophysiology== |
Template:Search infobox
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kalsang Dolma, MBBS
Synonyms and Keywords: papilloedema
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 retinal ganglion cells 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.
Causes
Common Causes
Hydrocephalus
Cerebral edema
Intracranial bleeding
Brain tumor
Cerebral venous sinus thrombosis
Idiopathic intracranial hypertension
Meningitis
Choroid plexus neoplasm
Hypertension
Causes by Organ System
| Cardiovascular
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Hypertension, Hypertensive encephalopathy, Hypertensive retinopathy
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| Chemical / poisoning
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Methanol, Ethylene glycol
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| Dermatologic
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No underlying causes
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| Drug Side Effect
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Cisplatin, Corticosteroid, Growth hormone treatment, Insulin-like growth factor 1, Interleukin 11, Isotretinoin, Lithium, Minocycline, Tetracycline
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| Ear Nose Throat
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No underlying causes
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| Endocrine
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Cushing's disease, Diabetic retinopathy, Thyroid opthalmopathy
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| Environmental
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No underlying causes
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| Gastroenterologic
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Acute liver failure
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| Genetic
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Camurati - Engelmann disease, Crouzon syndrome, Fabry's Disease, Tuberous sclerosis, Vogt-Koyanagi-Harada syndrome
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| Hematologic
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Acute lymphocytic leukemia
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| Iatrogenic
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No underlying causes
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| Infectious Disease
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Brucellosis, Epidural abscess, Infective endocarditis, Meningitis, Meningoencephalitis, Paragonimiasis, Syphillis, Toxoplasmosis
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| Musculoskeletal / Ortho
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Paget's disease
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| Neurologic
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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, Hydrocephalus, Cerebral edema, Gullian-Barre syndrome
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| Nutritional / Metabolic
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Nutritional optic neuropathy
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| Obstetric/Gynecologic
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Eclampsia
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| Oncologic
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Adult low grade infiltrative suoratentorial astrocytoma, Brain Stem Gliomas, Brain tumor, Chondroma, Choroid plexus neoplasm, Malignant Astrocytomas, Neuroectodermal tumor primitive, Osteoma, Tumor lysis syndrome, Acute lymphocytic leukemia
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| Opthalmologic
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Amaurosis fugax, Chorioretinitis, Glaucoma, Neuropapillitis, Optic disc drusen, Optic disc vasculitis, Optic neuritis, Orbital lesion, Orbital optic nerve tumors, Papillitis, Scleritis, Age related macular degeneration, Anterior ischemic optic neuropathy, Central retinal vein occlusion, Optic neuropathy
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| Overdose / Toxicity
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Arsenicals, Carbon monoxide toxity, Ethylene glycol
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| Psychiatric
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No underlying causes
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| Pulmonary
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Hypercapnia, Obesity hypoventilation syndrome, Respiratory acidosis
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| Renal / Electrolyte
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Acid Base Imbalance, Hypocalcemic tetany
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| Rheum / Immune / Allergy
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Sarcoidosis, Sympathetic ophthalmia, Systemic Lupus Erythematosus
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| Sexual
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No underlying causes
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| Trauma
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Head trauma
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| Urologic
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No underlying causes
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| Dental
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No underlying causes
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| Miscellaneous
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Idiopathic intracranial hypertension, POEMS syndrome, Deafness- peripheral- neuropathy- arterial disease
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Causes in Alphabetical Order
Differentiation of Papilledema from other Disorders
Papilledema should be distinguished from pseudopapilledema which is caused by
Epidemiology and Demographics
Papilledema occurs in approximately 50% of those with a brain tumour.
Diagnosis
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.
Physical Examination
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
