Papilledema

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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]

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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, Ethylene glycol
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 Brucellosis, Epidural abscess, Infective endocarditis, Meningitis, Meningoencephalitis, Paragonimiasis, Syphillis, Toxoplasmosis
Musculoskeletal / Ortho Paget's disease
Neurologic 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 recessive form, Epidural hematoma, Foster kennedy's syndrome, Intracranial hemorhage Medulloblastoma, Myoclonic epilepsy, Parinaud's syndrome, Subarachnoid hemorhage, Subdural empyema, Subdural hematoma

Nutritional / Metabolic Nutritional optic neuropathy
Obstetric/Gynecologic Eclampsia
Oncologic Adult low grade infiltrative suoratentorial astrocytoma, Brain Stem Gliomas, Brain tumor, Chondroma, Choroid plexus neoplasm, Malignant Astrocytomas, Neuroectodermal tumor primitive, Osteomas, Tumor lysis syndrome
Opthalmologic Amaurosis fugax, Chorioretinitis, Glaucoma, Neuropapillitis, Optic disc drusen, Optic disc vasculitis, Optic neuritis, Orbital lesion, Orbital optic nerve tumors, Papillitis, Retinal vein occlusion, Scleritis, Age related macular degeneration, Anterior ischemic optic neuropathy, Central retinal vein occlusion,
Overdose / Toxicity Arsenical, Carbon monoxide toxity, Ethylene glycol
Psychiatric No underlying causes
Pulmonary Hypercapnea, Obesity hypoventilation syndrome, Respiratory acidosis
Renal / Electrolyte Acid base imbalance, Hypocalcemic encephalopathy
Rheum / Immune / Allergy Sarcoidosis, Sympathetic ophthalmia, Systemic lupus erythematoses
Sexual No underlying causes
Trauma Head trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Idiopathic increase inratcranial tension, POEMS syndrome, Deafness- peripheral- neuropathy- arterial disease

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