Papilledema

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Papilledema Classification and external resources
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
eMedicine	oph/187
MeSH	D010211

WikiDoc Resources for Papilledema
Articles
Most recent articles on Papilledema Most cited articles on Papilledema Review articles on Papilledema Articles on Papilledema in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Papilledema Images of Papilledema Photos of Papilledema Podcasts & MP3s on Papilledema Videos on Papilledema
Evidence Based Medicine
Cochrane Collaboration on Papilledema Bandolier on Papilledema TRIP on Papilledema
Clinical Trials
Ongoing Trials on Papilledema at Clinical Trials.gov Trial results on Papilledema Clinical Trials on Papilledema at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Papilledema NICE Guidance on Papilledema NHS PRODIGY Guidance FDA on Papilledema CDC on Papilledema
Books
Books on Papilledema
News
Papilledema in the news Be alerted to news on Papilledema News trends on Papilledema
Commentary
Blogs on Papilledema
Definitions
Definitions of Papilledema
Patient Resources / Community
Patient resources on Papilledema Discussion groups on Papilledema Patient Handouts on Papilledema Directions to Hospitals Treating Papilledema Risk calculators and risk factors for Papilledema
Healthcare Provider Resources
Symptoms of Papilledema Causes & Risk Factors for Papilledema Diagnostic studies for Papilledema Treatment of Papilledema
Continuing Medical Education (CME)
CME Programs on Papilledema
International
Papilledema en Espanol Papilledema en Francais
Businness
Papilledema in the Marketplace Patents on Papilledema
Experimental / Informatics
List of terms related to Papilledema

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Overview

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 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

Cause

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.

Complete Differential Diagnosis of Papilledema

In alphabetical order. ^{[1] [1]}

• Arachnoid cyst
• Arnold chiari malformation
• Atypical optic neuritis
• Brain cyst
• Brain tumor
• Cavernous sinus thrombosis
• Central retinal vein occlusion
• Cerebral abscess
• Chondroma
• Cisplatin
• Corticosteroids
• Crouzon's disease
• Cushing's syndrome
• Diabetic papillopathy
• Eclampsia
• Epidural hematoma
• Extradural abscess
• Foster Kennedy's syndrome
• Grave's opthalmopathy
• Head trauma
• Hypercapnia
• Hyperparathyroidism
• Hypertensive encephalopathy
• Hypocalcemic tetany
• Idiopathic intracranial hypertension
• Intracranial hemorrhage
• Infectious endocarditis
• Lithium
• Hydrocephalus
• Malignant hypertension
• Meningitis
• Meningoencephalitis
• Neuropappilitis
• Optic disc vasculitis
• Orbital lesions
• Orbital optic nerve tumors
• Osteoma
• Paget's disease
• Papillitis
• Psuedopapilledema
• Sarcoidosis
• Subarachnoid hemorrhage
• Subdural empyema
• Subdural hematoma
• Syphillis
• Systemic lupus erythematosus
• Tetracyclines
• Thyrotoxicosis
• Uveitis

Presentation

There are 10 hallmarks of papilledema:

• blurring of the disc margins
• filling in of the optic disc cup
• anterior bulging of the nerve head
• edema of the nerve fiber layer
• retinal or choroidal folds
• congestion of retinal veins
• peripapillary hemorrhages
• hyperemia of the optic nerve head
• nerve fiber layer infarcts
• hard exudates of the optic disc

External links

• 8-101a. at Merck Manual of Diagnosis and Therapy Professional Edition
• EYE38 at FPnotebook
• eNotes

v • d • e Eye disease - pathology of the eye (H00-H59, 360-379)
Adnexa	eyelid: inflammation (Stye, Chalazion, Blepharitis) - Entropion - Ectropion - Lagophthalmos - Blepharochalasis - Ptosis - Blepharophimosis - Xanthelasma - Trichiasis lacrimal system: Dacryoadenitis - Epiphora - Dacryocystitis orbit: Exophthalmos - Enophthalmos
Eyeball	Conjunctiva Conjunctivitis (Allergic conjunctivitis) - Pterygium - Pinguecula - Subconjunctival hemorrhage Fibrous tunic sclera: Scleritis cornea: Keratitis - Corneal ulcer - Snow blindness - Thygeson's superficial punctate keratopathy - Fuchs' dystrophy - Keratoconus - Keratoconjunctivitis sicca - Arc eye - Keratoconjunctivitis - Corneal neovascularization - Kayser-Fleischer ring - Arcus senilis - Band keratopathy Iris and ciliary body Iritis - Uveitis - Iridocyclitis - Hyphema - Persistent pupillary membrane - Iridodialysis - Synechia Lens Cataract - Aphakia - Ectopia lentis Choroid Choroideremia - Choroiditis (Chorioretinitis) Retina Retinitis (Chorioretinitis) - Retinal detachment - Retinoschisis - Retinopathy (Bietti's crystalline dystrophy, Coats disease, Diabetic retinopathy, Hypertensive retinopathy, Retinopathy of prematurity) - Macular degeneration - Retinitis pigmentosa - Retinal haemorrhage - Central serous retinopathy - Macular edema - Epiretinal membrane - Macular pucker - Vitelliform macular dystrophy - Leber's congenital amaurosis - Birdshot chorioretinopathy
Optic nerve and visual pathways	Optic neuritis - Papilledema - Optic atrophy - Leber's hereditary optic neuropathy - Dominant optic atrophy - Optic disc drusen - Glaucoma - Toxic and nutritional optic neuropathy - Anterior ischemic optic neuropathy
Ocular muscles, binocular movement, accommodation and refraction	Paralytic strabismus: Ophthalmoparesis - Progressive external ophthalmoplegia - Palsy (III, IV, VI) - Kearns-Sayre syndrome Other strabismus: Esotropia/Exotropia - Hypertropia - Heterophoria (Esophoria, Exophoria) - Brown's syndrome - Duane syndrome Other binocular: Conjugate gaze palsy - Convergence insufficiency - Internuclear ophthalmoplegia - One and a half syndrome Refractive error: Hyperopia/Myopia - Astigmatism - Anisometropia/Aniseikonia - Presbyopia
Visual disturbances and blindness	Amblyopia - Leber's congenital amaurosis - Subjective (Asthenopia, Hemeralopia, Photophobia, Scintillating scotoma) - Diplopia - Scotoma - Anopsia (Binasal hemianopsia, Bitemporal hemianopsia, Homonymous hemianopsia, Quadrantanopia) - Color blindness (Achromatopsia, Dichromacy, Monochromacy) - Nyctalopia (Oguchi disease) - Blindness/Low vision
Pupil	Anisocoria - Argyll Robertson pupil - Marcus Gunn pupil/Marcus Gunn phenomenon - Adie syndrome - Miosis - Mydriasis - Cycloplegia
Infectious diseases	Trachoma - Onchocerciasis
Other	Nystagmus - Glaucoma/Ocular hypertension - Floater - Leber's hereditary optic neuropathy - Red eye - Keratomycosis - Xerophthalmia - Phthisis bulbi
See also congenital

v • d • e WikiDoc Research Resources for Papilledema
Articles on Papilledema	Most recent articles on Papilledema • Most cited articles on Papilledema • Review articles on Papilledema • Articles on Papilledema in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Papilledema	Powerpoint slides on Papilledema • Images of Papilledema • Photos of Papilledema • Podcasts & MP3s on Papilledema • Videos on Papilledema
Evidence Based Medicine Regarding Papilledema	Cochrane Collaboration on Papilledema • Bandolier on Papilledema • TRIP on Papilledema
Cost Effectiveness of Papilledema	Cost Effectiveness of Papilledema
Clinical Trials Involving Papilledema	Ongoing Trials on Papilledema at Clinical Trials.gov • Trial results on Papilledema • Clinical Trials on Papilledema at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Papilledema	US National Guidelines Clearinghouse on Papilledema • NICE Guidance on Papilledema • NHS PRODIGY Guidance • FDA on Papilledema • CDC on Papilledema
Textbook Information on Papilledema	Books and Textbook Information on Papilledema
Pharmacology Resources on Papilledema	Dosing of Papilledema • Drug interactions with Papilledema • Side effects of Papilledema • Allergic reactions to Papilledema • Overdose information on Papilledema • Carcinogenicity information on Papilledema • Papilledema in pregnancy • Pharmacokinetics of Papilledema •
Genetics, Pharmacogenomics, and Proteinomics of Papilledema	Genetics of Papilledema • Pharmacogenomics of Papilledema • Proteomics of Papilledema
Newstories on Papilledema	Papilledema in the news • Be alerted to news on Papilledema • News trends on Papilledema
Commentary on Papilledema	Blogs on Papilledema
Patient Resources on Papilledema	Patient resources on Papilledema • Discussion groups on Papilledema • Patient Handouts on Papilledema • Directions to Hospitals Treating Papilledema • Risk calculators and risk factors for Papilledema
Healthcare Provider Resources on Papilledema	Symptoms of Papilledema • Causes & Risk Factors for Papilledema • Diagnostic studies for Papilledema • Treatment of Papilledema
Continuing Medical Education (CME) Programs on Papilledema	CME Programs on Papilledema
International Resources on Papilledema	Papilledema en Espanol • Papilledema en Francais
Business Resources on Papilledema	Papilledema in the Marketplace • Patents on Papilledema
Informatics Resources on Papilledema	List of terms related to Papilledema

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .