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| | __NOTOC__ |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Papilledema | | | Name = Papilledema | |
| Image = Papilledema 1.jpg| | | 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>| | | 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 |
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| ICD10 = {{ICD10|H|47|1|h|46}} |
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| ICD9 = {{ICD9|377.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D010211 |
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| }} | | }} |
| {{Search infobox}} | | {{Papilledema}} |
| {{CMG}}; '''Associate Editor-In-Chief:''' Kalsang Dolma, M.D.
| | '''For patient information, click [[Papilledema (patient information)|here]]''' |
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| == Overview ==
| | {{CMG}}; {{AE}} {{KD}} |
| '''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]].
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| ==Pathophysiology==
| | '''''Synonyms and Keywords:''''' Papilloedema |
| 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.
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| 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.
| | ==[[Papilledema overview|Overview]]== |
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| 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.
| | ==[[Papilledema historical perspective|Historical Perspective]]== |
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| ==Differential diagnosis of causes of papilledema== | | ==[[Papilledema classification|Classification]]== |
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| ==Most common== | | ==[[Papilledema pathophysiology|Pathophysiology]]== |
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| | ==[[Papilledema causes|Causes]]== |
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| | ==[[Papilledema differential diagnosis|Differentiating Papilledema from other Diseases]]== |
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| | ==[[Papilledema epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Organ system based== | | ==[[Papilledema Natural History, Complications and Prognosis|Natural History, Complications and Prognosis]]== |
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Hypertension]], [[Hypertensive encephalopathy]], [[Hypertensive retinopathy]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| [[Methanol]], [[Ethylene glycol]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Cisplatin]], [[Corticosteroid]], [[Growth hormone treatment]], [[Insulin-like growth factor 1]], [[Interleukin 11]], [[Isotretinoin]], [[Lithium]], [[Minocycline]], [[Tetracycline]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Cushing's disease]], [[Diabetic retinopathy]], [[Thyroid opthalmopathy]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Acute liver failure]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Camurati - Engelmann disease]], [[Crouzon syndrome]], [[Fabry's Disease]], [[Tuberous sclerosis]], [[Vogt-Koyanagi-Harada syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Brucellosis]], [[Epidural abscess]], [[Infective endocarditis]], [[Meningitis]], [[Meningoencephalitis]], [[Paragonimiasis]], [[Syphillis]], [[Toxoplasmosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| [[Paget's disease]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Cavernous Sinus Thrombosis]], [[Arachnoid cyst]], [[Arnold chiari malformation]], [[Brain Abscess]], [[Brain cyst]], [[Brown - symmers disease]], [[Cerebellar abscess]],
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| [[Cerebral abscess]], [[Cerebral venous sinus thrombosis]], [[Dandy-Walker syndrome]], [[Epidural hematoma]], [[Foster kennedy syndrome]], [[Intracranial bleeding]]
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| [[Medulloblastoma]], [[Myoclonic epilepsy]], [[Parinaud's syndrome]], [[Subarachnoid hemmorhage]], [[Subdural empyema]], [[Subdural hematoma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Nutritional optic neuropathy]]
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| [[Eclampsia]]
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |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]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| [[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]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| [[Arsenicals]], [[Carbon monoxide toxity]], [[Ethylene glycol]]
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Hypercapnia]], [[Obesity hypoventilation syndrome]], [[Respiratory acidosis]]
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| [[Acid Base Imbalance]], [[Hypocalcemic tetany]]
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Sarcoidosis]], [[Sympathetic ophthalmia]], [[Systemic Lupus Erythematosus]]
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| [[Head trauma]]
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| [[Idiopathic intracranial hypertension]], [[POEMS syndrome]], [[Deafness- peripheral- neuropathy- arterial disease]]
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| |-
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| |}
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| ==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>==
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| *[[Arachnoid cyst]]
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| *[[Arnold chiari malformation]]
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| *Atypical [[optic neuritis]]
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| *[[Brain cyst]]
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| *[[Brain tumor]]
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| *[[Cavernous sinus thrombosis]]
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| *[[Central retinal vein occlusion]]
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| *[[Cerebral abscess]]
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| *[[Chondroma]]
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| *[[Cisplatin]]
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| *[[Corticosteroids]]
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| *[[Crouzon's disease]]
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| *[[Cushing's syndrome]]
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| *[[Diabetic]] papillopathy
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| *[[Eclampsia]]
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| *[[Epidural hematoma]]
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| *Extradural [[abscess]]
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| *Foster Kennedy's syndrome
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| *[[Grave's opthalmopathy]]
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| *[[Head trauma]]
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| *[[Hypercapnia]]
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| *[[Hyperparathyroidism]]
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| *Hypertensive [[encephalopathy]]
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| *[[Hypocalcemic tetany]]
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| *Idiopathic [[intracranial hypertension]]
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| *[[Intracranial hemorrhage]]
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| *Infectious [[endocarditis]]
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| *[[Lithium]]
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| *[[Hydrocephalus]]
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| *[[Malignant hypertension]]
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| *[[Meningitis]]
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| *[[Meningoencephalitis]]
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| *Neuropappilitis
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| *[[Optic disc]] [[vasculitis]]
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| *Orbital lesions
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| *Orbital [[optic nerve]] tumors
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| *[[Osteoma]]
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| *[[Paget's disease]]
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| *Papillitis
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| *Psuedopapilledema
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| *[[Sarcoidosis]]
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| *[[Subarachnoid hemorrhage]]
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| *[[Subdural empyema]]
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| *[[Subdural hematoma]]
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| *[[Syphillis]]
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| *[[Systemic lupus erythematosus]]
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| *[[Tetracyclines]]
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| *[[Thyrotoxicosis]]
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| *[[Uveitis]]
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| ==Diagnosis== | | ==Diagnosis== |
| | [[Papilledema history and symptoms|History and Symptoms]] | [[Papilledema physical examination|Physical Examination]] | [[Papilledema CT|CT]] | [[Papilledema MRI|MRI]] | [[Papilledema other imaging findings|Other Imaging Findings]] | [[Papilledema other diagnostic studies|Other Diagnostic Studies]] |
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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.
| | ==Treatment== |
| | | [[Papilledema medical therapy|Medical Therapy]] | [[Papilledema surgery|Surgery]] | [[Papilledema primary prevention|Primary Prevention]] | [[Papilledema cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Papilledema future or investigational therapies|Future or Investigational Therapies]] |
| === Physical Examination ===
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| ==== Eyes ====
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| [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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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Papilledema 1.jpg|Papilledema.
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| Image:Pseudopapilledema.jpg|Pseudopapilledema.
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| </gallery>
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| There are 10 hallmarks of '''papilledema''':
| | == Case Studies == |
| *Blurring of the [[disc margins]]
| | [[Papilledema case study one|Case #1]] |
| *Filling in of the [[optic disc cup]]
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| *Anterior bulging of the [[nerve head]]
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| *Edema of the nerve fiber layer
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| *Retinal or [[choroidal]] folds
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| *Congestion of [[retinal veins]]
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| *Peripapillary [[hemorrhages]]
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| *Hyperemia of the optic nerve head
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| *Nerve fiber layer infarcts
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| *Hard exudates of the [[optic disc]]
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| ==References== | | ==Related Chapters== |
| {{Reflist|2}}
| | * [[Cerebral edema]] |
| | * [[Intracranial pressure]] |
| | * [[Raised intracranial pressure]] |
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| {{Eye pathology}} | | {{Eye pathology}} |
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| [[de:Stauungspapille]]
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| [[it:Papilledema]]
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| [[Category:Neurology]] | | [[Category:Neurology]] |
| | [[Category:Medical signs]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| | | [[Category:Intensive care medicine]] |
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