Papilledema overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Papilledema

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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

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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.

Pathophysiology

Papilledema is in general the result of transmission of increased intracranial pressure[1] to the anterior end of optic nerve through optic nerve sheath.

Causes

Papilledema can be caused by conditions which increase intracranial pressure. Increase in the volume of any of the cranium contents, the brain, cerebrospinal fluid and / or blood can cause increased intracranial pressure.

Epidemiology and Demographics

Papilledema occurs in approximately 50% of patients with a brain tumour.

Differentiating Papilledema from other Diseases

Papilledema should be distinguished from pseudopapilledema

Natural History, Complications and Prognosis

Papilledema regresses if the underlying cause is treated and if not can lead to vision loss.

Diagnosis

History and Symptoms

Patients with papilledema usually present with signs and symptoms of increased intracranial pressure and can lead to vision loss if the underlying condition is not treated.

Physical Examination

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

Treatment

Medical Therapy

The best treatment of papilledema is to address its underlying cause. However the root cause of papilledema is increase intracranial pressure. Drugs are use to decrease intracranial pressure. These drugs acts mainly by either decreasing cerebrospinal fluid production or by increasing its outflow.

Surgery

Surgical treatment of papilledema depends on the underlying cause. Various surgeries including shunt surgeries, craniotomies and optic nerve sheath fenestration can be done depending on the cause.

References

  1. Tso MO, Hayreh SS (1977). "Optic disc edema in raised intracranial pressure. IV. Axoplasmic transport in experimental papilledema". Arch. Ophthalmol. 95 (8): 1458–62. PMID 70201. Unknown parameter |month= ignored (help)


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