Papilledema physical examination

Jump to navigation Jump to search

Papilledema

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Papilledema from other Diseases

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Papilledema physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Papilledema physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Papilledema physical examination

CDC on Papilledema physical examination

Papilledema physical examination in the news

Blogs on Papilledema physical examination

Directions to Hospitals Treating Papilledema

Risk calculators and risk factors for Papilledema physical examination

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

Overview

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

Physical Examination

Vital signs: look for blood pressure to rule out hypertension

Eyes Examination 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