Papilledema 199340 224613136 2008-07-09T17:36:03Z AlexandriNo 1640494 wikification {{Infobox_Disease | Name = Papilledema | Image = | Caption = | DiseasesDB = 9580 | ICD10 = {{ICD10|H|47|1|h|46}} | ICD9 = {{ICD9|377.0}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = oph | eMedicineTopic = 187 | MeshID = D010211 | }} '''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 has many possible causes but is known to occur in approximately 50% of those with a [[brain tumor]].{{fact|date=January 2008}} ==Signs and symptoms== In its earliest stages papilledema may not cause any symptoms, but more severe papilledema leads to blurriness in vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and actual loss of vision. ==Diagnosis== Checking the [[eye]]s for [[sign (medicine)|sign]]s of papilledema should be carried out whenever there is a clinical suspicion of raised [[intracranial pressure]], and is recommended in newly onset [[headache]]s. This may be done by [[ophthalmoscopy]] or [[slit lamp]] examination. There are 10 hallmarks of papilledema:{{fact|date=January 2008}} *blurring of the [[optic disc]] margins *filling in of the [[optic disc cup]] *anterior bulging of the [[nerve head]] *[[edema]] of the nerve fiber layer *[[retina|retinal]] or [[choroid|choroidal]] folds *congestion of [[retinal vein]]s *peripapillary [[hemorrhages]] *[[hyperemia]] of the optic nerve head *nerve fiber layer infarcts *hard [[exudate]]s of the [[optic disc]] ==Causes== {{expand|date=January 2008}} * Raised [[intracranial pressure]]: [[brain tumor]], ''[[pseudotumor cerebri]]'' or [[cerebral venous sinus thrombosis]], [[cerebral hemorrhage|Intracerebral hemorrhage]] * [[Respiratory failure]]<ref>{{cite journal |author=Cameron AJ |title=Marked papilloedema in pulmonary emphysema |journal=Br J Ophthalmol |volume=17 |issue=3 |pages=167–9 |year=1933 |pmid=18169104 |doi=10.1136/bjo.17.3.167}} {{PMC|511527}}</ref> * [[Hypotonia]] * [[Accutane]] (Isotrentin), which is a powerful derivative of [[Vitamin A]], rarely causes Papilledema. * [[Guillain-Barre syndrome]] due to elevated [[protein]] levels ==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 [[Ganglion cell|retinal ganglion cell]]s 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. ==Treatment== {{expand|date=January 2008}} The treatment depends largely on the underlying cause. For instance, raised intracranial pressure may improve with [[glucocorticoid]]s, [[acetazolamide]] or surgical shunting. ==References== <references/> ==External links== * {{MerckManual|8|101|a}} * {{FPnotebook|EYE38}} * [http://health.enotes.com/medicine-encyclopedia/papilledema eNotes] {{Eye pathology}} [[Category:Medical signs]] [[Category:Neurology]] [[de:Stauungspapille]] [[it:Papilledema]] [[pt:Papiledema]]