Papilledema

Background

Bilateral optic disc swelling due to increased ICP

Etiology

Malignant hypertension
Idiopathic intracranial hypertension (pseudotumor cerebri)
Intracranial mass
Hydrocephalus
Cerebral edema

Clinical Features

Increased ICP symptoms:
- Headache (esp with recumbency and in the morning)
- Nausea and vomiting
Preservation of visual acuity
- May have visual obscurations that clear completely lasting seconds

Fundoscopy

Loss of spontaneous venous pulsations
Disc margin blurring
Cup is diminished or absent

Differential Diagnosis

Malignant hypertension
Idiopathic intracranial hypertension (pseudotumor cerebri)
Intracranial mass
Hydrocephalus
Cerebral edema
Salicylate toxicity

Evaluation

MRI
CT (if MRI unavailable)
LP (if neuroimaging normal)
- Opening pressure >25 considered abnormal

Management

Treat underlying condition

See Also

Increased ICP

References

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