Exam

Papilledema

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Papilledema

  • Signs
  1. Early and mild Papilledema
    1. Subtle gray peripapillary halo
      1. Normal radial Optic Nerve Head disrupted
      2. Nerve fibers accentuated by grayish opacity
    2. Concentric folds of the retinochoroid
  2. Moderate Papilledema
    1. Borders of optic disc become obscure
    2. Disc margins are progressively elevated
    3. Nerve head diameter increases
    4. Major blood vessels leaving the disc are obscured
  3. Severe Papilledema
    1. Optic Nerve Head protrudes
    2. Peripapillary halo demarcated
    3. Optic Cup is obliterated
  • Signs
  • Associated findings
  1. Loss of spontaneous Retinal vein pulsations
    1. Pulsations disappear at CSF Pressure > 250 mm water
    2. Unreliable sign
      1. Many normal patients lack venous pulsations
  2. Hyperemia
  3. Retinal vessel tortuosity
  4. Retinal Hemorrhages
  5. Retinal exudates
  6. Nerve fiber infarctions (cotton wool spots)
  7. Optic Nerve pallor
  • Interpretation
  1. Suggests Increased Intracranial Pressure
  • Causes
  • Pseudopapilledema
  1. Optic disc drusen
  2. Tilted optic disc
  • Diagnostics
  1. Stereoscopic indirect Fundoscopy
  2. Optic Nerve Ultrasound
    1. Drusen are highly reflective
    2. Papilledema shows a distended Optic Nerve sheath