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
MeSH D010211

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

Synonyms and Keywords: papilloedema

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.

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.

Causes

Common Causes

Hydrocephalus

Cerebral edema

Intracranial bleeding

Brain tumor

Cerebral venous sinus thrombosis

Idiopathic intracranial hypertension

Optic neuritis

Optic neuropathy

Choroid plexus neoplasm

Hypertension

Causes by Organ System

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, Crouzon syndrome, Fabry's Disease, Tuberous sclerosis, Vogt-Koyanagi-Harada syndrome
Hematologic Acute lymphocytic leukemia
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, Epidural hematoma, Foster kennedy syndrome, Intracranial bleeding Medulloblastoma, Myoclonic epilepsy, Parinaud's syndrome, Subarachnoid hemmorhage, Subdural empyema, Subdural hematoma, Hydrocephalus, Cerebral edema, Gullian-Barre syndrome

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, Osteoma, Tumor lysis syndrome, Acute lymphocytic leukemia
Opthalmologic Amaurosis fugax, Chorioretinitis, Glaucoma, Neuropapillitis, Optic disc drusen, Optic disc vasculitis, Optic neuritis, Orbital lesion, Orbital optic nerve tumors, Papillitis, Scleritis, Age related macular degeneration, Anterior ischemic optic neuropathy, Central retinal vein occlusion, Optic neuropathy
Overdose / Toxicity Arsenicals, Carbon monoxide toxity, Ethylene glycol
Psychiatric No underlying causes
Pulmonary Hypercapnia, Obesity hypoventilation syndrome, Respiratory acidosis
Renal / Electrolyte Acid Base Imbalance, Hypocalcemic tetany
Rheum / Immune / Allergy Sarcoidosis, Sympathetic ophthalmia, Systemic Lupus Erythematosus
Sexual No underlying causes
Trauma Head trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Idiopathic intracranial hypertension, POEMS syndrome, Deafness- peripheral- neuropathy- arterial disease

Causes in Alphabetical Order [1] [2]

Acid Base Imbalance

Acute liver failure

Acute lymphocytic leukemia

Adult low grade infiltrative suoratentorial astrocytoma

Age related macular degeneration

Amaurosis fugax

Anterior ischemic optic neuropathy

Arachnoid cyst

Arnold chiari malformation

Arsenicals

Brain Abscess

Brain cyst

Brain Stem Gliomas

Brain tumor

Brown - symmers disease

Brucellosis

Camurati-Engelmann disease

Carbon monoxide toxity

Cavernous Sinus Thrombosis

Central retinal vein occlusion

Cerebellar abscess

Cerebral abscess

Cerebral edema

Cerebral venous sinus thrombosis

Chondroma

Chorioretinitis

Choroid plexus neoplasm

Cisplatin

Corticosteroid

Crouzon syndrome

Cushing's disease

Dandy-Walker syndrome

Deafness- peripheral- neuropathy- arterial disease

Diabetic retinopathy

Eclampsia

Epidural abscess

Epidural hematoma

Ethylene glycol

Fabry's Disease

Foster Kennedy syndrome

Glaucoma

Growth hormone treatment

Gullian-Barre syndrome

Head trauma

Hydrocephalus

Hypercapnia

Hypertension

Hypertensive encephalopathy

Hypertensive retinopathy

Hypocalcemic tetany

Idiopathic intracranial hypertension

Infective endocarditis

Insulin like growth factor 1

Interleukin 11

Intracranial bleeding

Isotretinoin

Lithium

Malignant Astrocytomas

Medulloblastoma

Meningitis

Meningoencephalitis

Methanol

Minocycline

Myoclonic epilepsy

Neuroectodermal tumor primitive

Neuropapillitis

Nutritional optic neuropathy

Obesity hypoventilation syndrome

Optic disc drusen

Optic disc vasculitis

Optic neuritis

Optic neuropathy

Orbital lesion

Orbital optic nerve tumors

Osteoma

Paget's disease

Papillitis

Paragonimiasis

Parinaud's syndrome

POEMS syndrome

Respiratory acidosis

Sarcoidosis

Scleritis

Subarachnoid hemmorhage

Subdural empyema

Subdural hematoma

Sympathetic ophthalmia

Syphillis

Systemic Lupus Erythematosus

Tetracycline

Thyroid opthalmopathy

Toxic optic neuropathy

Toxoplasmosis

Tuberous sclerosis

Tumor lysis syndrome

Vogt-Koyanagi-Harada syndrome

Differentiation of Papilledema from other Disorders

Papilledema should be distinguished from pseudopapilledema which is caused by

Epidemiology and Demographics

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

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

There are 10 hallmarks of papilledema:

References

  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

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