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Papilledema
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Although the term “papilledema” may be used commonly to describe any type of optic disc swelling, it is preferable to confine its application to conditions in which the optic nerve swells secondary to elevated intracranial pressure (ICP). This definition is specific to the English language, as there is no similar means of separating different types of optic disc swelling by nomenclature alone in other languages. Other types of optic disc swelling from inflammation, infection, demyelinating disease, and other processes have a separate means of pathogenesis; in fact, it is this distinctive causation of papilledema that allows the clinician to differentiate it from other types of disc swelling. Except in unusual circumstances or in cases in which there is optic atrophy as well as optic disc swelling, the objective severity of the optic disc swelling in papilledema is usually much greater than the degree of vision loss (swelling out of proportion to vision loss). A similar degree of swelling from inflammation or infection will, in contrast, result in severe loss of both visual acuity and visual field. Indeed, true papilledema with severe vision loss should be considered a very ominous sign of advanced disease that may portend a poor visual prognosis (Figure 6.1).
Pseudotumor Cerebri/Idiopathic Intracranial Hypertension (IIH)
Published in Charles Theisler, Adjuvant Medical Care, 2023
pseudotumor means “false brain tumor” because the symptoms and signs are similar to a brain tumor. Nearly all patients have headaches, often daily, and are worse upon wakening or with eye movement. Vomiting, blurred or dimmed vision, and papilledema may be present. Pseudotumor cerebri is a difficult diagnosis to establish. The main goals of treatment are to preserve vision and to reduce the severity of headaches.
Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
Papilledema is swelling of the optic nerve due to elevated intracranial pressure (ICP). Appearance can range from mild c-shaped swelling that spares the temporal margin to severe 360-degree swelling with hemorrhages, cotton wool spots, and obscuration of the blood vessels on the disc surface (Figure 22.10). It can be considered a compressive optic neuropathy where compression is caused by high CSF pressure in the optic nerve sheath.
Intraventricular neurocysticercosis causing obstructing hydrocephalus
Published in Baylor University Medical Center Proceedings, 2022
Alejandro Perez, Gaurav Syngal, Samreen Fathima, Sam Laali, Sadat Shamim
Neurocysticercosis is caused by the pork tapeworm Taenia solium.1 Intraventricular neurocysticercosis, which occurs in 10% to 20% of cases, develops when cysticerci become lodged in the ventricular outflow tracks, with consequent obstructive hydrocephalus and increased intracranial pressure.2 Associated symptoms include headache, nausea, vomiting, altered mental status, and decreased visual acuity with papilledema.3 Less frequent symptoms include seizures and focal neurologic signs, usually from coexistent disease in the parenchyma or subarachnoid space.4 Occasionally, mobile cysts in the third and fourth ventricle can cause intermittent obstruction, leading to episodes of sudden loss of consciousness related to head movements (Bruns syndrome).5 We present a case of neurocysticercosis involving obstruction of the fourth ventricle leading to hydrocephalus.
Serum glial fibrillary acidic protein (GFAP)-antibody in idiopathic intracranial hypertension
Published in International Journal of Neuroscience, 2021
Berrak Yetimler, John Tzartos, Büşra Şengül, Erdinç Dursun, Çağrı Ulukan, Katerina Karagiorgou, Duygu Gezen-Ak, Mine Sezgin, Aliki Papaconstantinou, Socrates Tzartos, Elif Kocasoy Orhan, Esme Ekizoğlu, Cem İsmail Küçükali, Betül Baykan, Erdem Tüzün
A total of 58 IIH patients (52 women, 6 men) with an average age of 30.8 ± 8.5 years were investigated. The presenting symptom at the time of admission was headache in 44 patients and visual symptoms such as cloudy vision, transient visual obscurations and diplopia in 14 patients. The mean (± standard deviation) body mass index of the patients was 32.3 ± 7.2 kg/m2. Neurologic examination showed papilledema in 50 patients and vision loss or visual field defects in 45 patients. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) investigations were normal except for non-specific white matter lesions and transverse sinus hypoplasia, respectively. CSF analysis did not reveal any abnormalities other than increased opening CSF pressure (399.3 ± 157.4 mmH2O).
Outcomes measures in idiopathic intracranial hypertension
Published in Expert Review of Neurotherapeutics, 2021
Susan P Mollan, Alexandra J Sinclair
Papilledema is a reliable sign of raised intracranial pressure [57]. Change in papilledema has been used by all randomized control trials in IIH to date to determine clinical improvement (Table 1). Change in papilledema has either been graded by experts using the Frisén classification [58] and more recently reliably measured by optical coherence tomography (OCT) imaging. Waisbourd et al [59] reported on 91 eyes of 48 patients, and showed that the OCT peripapillary retinal nerve fiber layer (pRNFL)(Figure 1) could discriminate between different degrees of optic nerve head (ONH) swelling correlating with clinical appearance of the optic nerves on fundoscopy. The average pRNFL thickness was statistically different between the groups: normal optic disc/mild elevation group (N = 20) – 89 μm (95% CI, 80–98 μm), mild elevation group (N = 51) – 109 μm (95% CI, 101–117 μm), and papilledema group (N = 20) 124 μm (95% CI, 100–153 μm) (P = 0.004). Hence, pRNFL may be a better measure of categorization of papilledema over Frisén grading, as it is a continuous measure and not a categorical scale [59].