papilliedema

Papilledema(orpapilloedema) is optic discswelling 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. Papilledema is mostly seen as a symptom resulting from another pathophysiological process. In intracranial hypertension, papilledema most commonly occurs bilaterally. When papilledema is found on fundoscopy, further evaluation is warranted as vision loss can result if the underlying condition is not treated. Further evaluation with a CT or MRI of the brain and/or spine is usually performed. Unilateral papilledema can suggest orbital pathology, such as an optic nerve glioma. Signs and symptoms Fundal photograph showing less severe papilledema Papilledema may be asymptomatic or present with headache in the early stages. However it may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision may occur. The signs of papilledema that are seen using an ophthalmoscopeinclude: *.venous engorgement (usually the first signs) *.loss of venous pulsation *.hemorrhages over and / or adjacent to the optic disc *.blurring of optic margins *.elevation of optic disc *.Paton's lines = radial retinal lines cascading from the optic disc On visual fieldexamination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged. Diagnosis Checking the eyesfor signsof papilledema should be carried out whenever there is a clinical suspicion of raised intracranial pressure, and is recommended in newly onset headaches. This may be done by ophthalmoscopyor fundus photography, and possibly slit lampexamination. Causes Raised intracranial pressureas a result of one or more of the following: *. Brain tumor, Pseudotumor Cerebri(also known as Idiopathic Intracranial Hypertension), Cerebral venous sinus thrombosisor Intracerebral hemorrhage *. Respiratory failure [ 1 ] *. Hypotonia *. Isotretinoin, which is a powerful derivative of Vitamin A, rarely causes papilledema. *. Hypervitaminosis A, in some people who take megadoses of nutritional supplements and vitamins. *. Hyperammonemia, elevated level of ammonia in blood (including cerebral edema/intracranial pressure) *. Guillain-Barré syndrome, due to elevated proteinlevels *. Foster Kennedy syndrome(FKS) *. Chiari Malformation *. Tumorsof the frontal lobe *. Acute Mountain Sicknessand High-altitude cerebral edema *. Lyme disease(Lyme meningitisspecifically, when the bacterial infection is in the central nervous system, causing increased intracranial pressure). *. Malignant Hypertension *. Medulloblastoma *.Orbital *. Glaucoma: Central retinal vein occlusion, Cavernous sinus thrombosis *.Local lesion: Optic neuritis, Ischemic optic neuropathy, Methanol poisoning, infiltration of the discby Glioma, Sarcoidosisand Lymphoma *.Acute Lymphocytic leukemia(caused by infiltration of the retinal vessels by immature leukocytes) *.Long periods of weightlessness( microgravity) for males