Papilledema: Difference between revisions

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{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Hypertension]], [[Hypertensive encephalopathy]], [[Hypertensive retinopathy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Methanol]], [[Toxic optic neuropathy]]
|-
|-
|-bgcolor="LightSteelBlue"
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| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|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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| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cushing's disease]], [[Diabetic retinopathy]], [[Thyroid opthalmopathy]]
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|-
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| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Acute liver failure]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Camurati - Engelmann disease]], [[Cruzon's disease]], [[Fabry's Disease]], [[Tuberous sclerosis]], [[Vogt - koyanagi-harada disease]]
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==In alphabetical order==
==In alphabetical order==

Revision as of 18:51, 13 July 2012

Papilledema
Papilledema.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
ICD-10 H47.1
ICD-9 377.0
DiseasesDB 9580
eMedicine oph/187 
MeSH D010211

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Template:Editor help

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 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.

Differential diagnosis of causes of papilledema

Most common

Organ system based

Cardiovascular Hypertension, Hypertensive encephalopathy, Hypertensive retinopathy
Chemical / poisoning Methanol, Toxic optic neuropathy
Dermatologic No underlying causes
Drug Side Effect Cisplatin, Corticosteroid, Growth hormone treatment, Insulin like growth factor 1, Interleukin 11, Isotretinoin, Lithium, Minocycline, Tetracycline
Ear Nose Throat No underlying causes
Endocrine Cushing's disease, Diabetic retinopathy, Thyroid opthalmopathy
Environmental No underlying causes
Gastroenterologic Acute liver failure
Genetic Camurati - Engelmann disease, Cruzon's disease, Fabry's Disease, Tuberous sclerosis, Vogt - koyanagi-harada disease
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

In alphabetical order

[1] [2]

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

Presentation

There are 10 hallmarks of papilledema:

External links

Template:SIB de:Stauungspapille it:Papilledema


Template:WikiDoc Sources

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