papiledema

Papilledema is the swelling of the optic disc caused by increased intracranial pressure. It is a significant clinical sign indicating elevated pressure within the skull, which can result from various neurological conditions such as brain tumors, intracranial hemorrhages, or infections.

Typically, papilledema develops gradually and is bilateral, affecting both optic nerves. The condition manifests with symptoms including transient visual obscurations, headache, nausea, vomiting, and sometimes a decrease in visual acuity. On fundoscopic examination, the optic disc appears swollen with blurred margins, and there may be hemorrhages or elevation of the disc.

The etiology of papilledema primarily involves increased intracranial pressure that is transmitted along the subarachnoid space surrounding the optic nerve. This pressure causes axoplasmic flow stasis within the optic nerve fibers, leading to swelling.

Diagnosis involves a comprehensive neurological and ophthalmological assessment. Fundoscopy remains the primary diagnostic tool, revealing characteristic disc swelling. Additional imaging studies such as MRI or CT scans help identify underlying causes. Measurement of intracranial pressure via lumbar puncture may also be necessary.

Management of papilledema focuses on reducing intracranial pressure and treating the underlying cause. Therapeutic options include medications such as diuretics (e.g., acetazolamide), corticosteroids, or surgical interventions like ventriculoperitoneal shunting when applicable.

Early recognition and treatment of papilledema are crucial to prevent permanent optic nerve damage and preserve vision. Regular monitoring is essential for patients with persistent intracranial hypertension.