Papilledema is a swelling of the optic disc due to increased intracranial pressure. This condition is usually accompanied by decreased vision. The symptoms of papilledema can be unilateral or bilateral, and they are caused by a variety of different conditions. If a patient has papilledema, the doctor will need to perform neuroimaging, including magnetic resonance imaging (MRI), to determine the cause of the edema. These tests can also detect brain tumors, which can be treated by radiation. In addition, a lumbar puncture with a measurement of the pressure in the cerebrospinal fluid can be used to rule out mass lesions. A venogram can also be performed to assess for venous sinus thrombosis. Typically, treatment for papilledema involves medication, such as acetazolamide, to reduce the intracranial pressure. Treatment may also involve surgery.
When the intracranial pressure is elevated, the nerve fiber layer on the retinal nerves enlarges and the blood vessels passing over the disc are obstructed. Papilledema occurs in a spectrum of grades from mild to severe. Each grade has a specific set of symptoms. For instance, grade 1 papilledema is characterized by a C-shaped halo with a temporal gap. Grade 2 papilledema is characterized primarily by a circumferential halo. And grade 3 papilledema is characterized with obscuration of the major blood vessels leaving the disc.
While the symptoms of papilledema are not always immediate, they can lead to serious damage to the optic nerve. Therefore, it is important to promptly diagnose papilledema. Patients with suspected papilledema should be admitted to a hospital for further testing. Some patients may also have to undergo a ventriculoperitoneal shunt to relieve the pressure inside the head. Other treatments are directed at the underlying cause.
Papilledema is most often caused by increased intracranial pressure, but can occur as a result of a range of other causes. This can make it difficult to distinguish between papilledema and other swelling of the optic disc. It can be particularly tricky when a patient has a history of a headache, as the sudden onset of a migraine can sometimes mimic papilledema.
Papilledema can be accompanied by hemorrhages. These can be peripapillary or perihyaloid in location. Occasionally, the hemorrhages can be more than two disc diameters away from the optic nerve head. However, the majority of hemorrhages are in the retina. Disc drusen are another potential source of hemorrhages. Papilledema can also be associated with a hemorrhage in the subarachnoid space.
Papilledema symptoms usually resolve over weeks or months. However, if the papilledema is chronic, it can eventually lead to permanent damage to the nerve fibers. As such, it is important to monitor the patient for any changes in vision. Painkillers, such as topiramate, can help to alleviate the symptoms.
MRI with gadolinium contrast is recommended for patients with suspected papilledema. If there is a risk of a tumor, a biopsy should be performed. Magnetic resonance venograms are also available. Although a venogram is necessary to assess for venous sinus thrombosis, it can also be useful to rule out other possible tumors, such as glioma.
