Papilledema - Revision history

Benalexander: /* Etiology */

2025-08-22T21:11:08Z

Etiology

← Older revision		Revision as of 21:11, 22 August 2025
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	*All causes of [[elevated intracranial pressure]]		*All causes of [[elevated intracranial pressure]]
	**[[Intracranial mass]]		**[[Intracranial mass]]
	**Decreased CSF resorption		**Decreased CSF outflow or resorption
	**Increased CSF production or cerebral blood flow		**Increased CSF production or cerebral blood flow
	*Most commonly caused by [[Idiopathic intracranial hypertension]] in individuals under 50.<ref name="Xie">Xie JS, et al. Papilledema: A review of etiology, pathophysiology, diagnosis, and management. ''Surv Ophthalmol''. 2022;67(4):1135-1159.</ref>		*Most commonly caused by [[Idiopathic intracranial hypertension]] in individuals under 50.<ref name="Xie">Xie JS, et al. Papilledema: A review of etiology, pathophysiology, diagnosis, and management. ''Surv Ophthalmol''. 2022;67(4):1135-1159.</ref>

2025-08-22T20:53:37Z

Evaluation

← Older revision		Revision as of 20:53, 22 August 2025
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	==Evaluation==		==Evaluation==
	*[[~~brain MRI\|MRI~~]]		*Careful [[neurologic exam]] including level of consciousness, pupils, and cranial nerves (especially CN VI-Abducens)
	*[[head CT\|CT~~]] (if~~ MRI ~~unavailable)~~		*Fundoscopic exam without dilation is often difficult - consider [[ocular ultrasound]] to assess optic nerve diameter
	*[[LP]] (if neuroimaging normal)		*[[Brain MRI]] with MR venography to identify secondary causes of elevated ICP
			**Non-contrast head CT with CT venography may be a reasonable alternative depending on practice setting and patient urgency. Follow-up MRI may be required.
			*[[Lumbar Puncture]] (if neuroimaging normal)
	**Opening pressure >25 considered abnormal		**Opening pressure >25 considered abnormal

2025-08-22T20:03:25Z

Differential Diagnosis: Expand differential, include CVT

← Older revision		Revision as of 20:03, 22 August 2025
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Malignant hypertension]]		*[[Idiopathic intracranial hypertension]] (other causes must be excluded)
	*[[Idiopathic intracranial hypertension]] (~~pseudotumor cerebri~~)
	*[[Intracranial mass]]		*[[Intracranial mass]]
	*[[Hydrocephalus]]		*[[Hydrocephalus]]
			*[[Cerebral venous thrombosis]]
	*Cerebral edema		*Cerebral edema
	*[[Salicylate toxicity]]		**[[Ischemic stroke]]
			**[[Head trauma (main)\|Traumatic brain injury]]
			**[[Salicylate toxicity]]
			**[[Meningitis]]
			**[[Encephalitis]]
			**[[Posterior reversible encephalopathy syndrome]]

	==Evaluation==		==Evaluation==

2025-08-22T19:35:36Z

Clinical Features: reference for visual obscurations

← Older revision		Revision as of 19:35, 22 August 2025
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	**[[Headache]] (esp with recumbency and in the morning)		**[[Headache]] (esp with recumbency and in the morning)
	**[[Nausea and vomiting]]		**[[Nausea and vomiting]]
	*~~Preservation of visual~~ acuity		*Visual disturbance
	**May have visual obscurations that clear completely ~~lasting seconds~~		**Visual acuity is usually normal or near-normal in the acute phase
			**May have transient visual obscurations (blurriness or white out) that last seconds, then clear completely.<ref name="Xie" />
			***These may be triggered by position change or Valsalva

	===[[Fundoscopy]]===		===[[Fundoscopy]]===

2025-08-22T19:26:53Z

Background: Removed duplication of etiology with diff dx. Added reference

← Older revision		Revision as of 19:26, 22 August 2025
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	==Background==		==Background==
	*Bilateral optic disc swelling due to increased ICP		*Bilateral optic disc swelling due to increased ICP
			*This may sometimes be a presenting complaint, referred by an eye care provider, though will usually have associated symptoms such as headache, altered mental status, or vision changes.

	===Etiology===		===Etiology===
	*[[~~Malignant hypertension~~]]		*All causes of [[elevated intracranial pressure]]
	*~~[[Idiopathic intracranial hypertension]] (pseudotumor cerebri)~~		**[[Intracranial mass]]
	*[[Intracranial mass]]		**Decreased CSF resorption
	*[[~~Hydrocephalus~~]]		**Increased CSF production or cerebral blood flow
	*Cerebral edema		*Most commonly caused by [[Idiopathic intracranial hypertension]] in individuals under 50.<ref name="Xie">Xie JS, et al. Papilledema: A review of etiology, pathophysiology, diagnosis, and management. ''Surv Ophthalmol''. 2022;67(4):1135-1159.</ref>

	==Clinical Features==		==Clinical Features==

2019-10-06T21:31:46Z

Clinical Features

← Older revision		Revision as of 21:31, 6 October 2019
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	**May have visual obscurations that clear completely lasting seconds		**May have visual obscurations that clear completely lasting seconds

	===Fundoscopy===		===[[Fundoscopy]]===
			[[File:Papilledema.jpg\|thumb\|]]
	*Loss of spontaneous venous pulsations		*Loss of spontaneous venous pulsations
	*Disc margin blurring		*Disc margin blurring

2019-10-02T00:29:26Z

Evaluation

← Older revision		Revision as of 00:29, 2 October 2019
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	==Evaluation==		==Evaluation==
	*MRI		*[[brain MRI\|MRI]]
	*CT (if MRI unavailable)		*[[head CT\|CT]] (if MRI unavailable)
	*[[LP]] (if neuroimaging normal)		*[[LP]] (if neuroimaging normal)
	**Opening pressure >25 considered abnormal		**Opening pressure >25 considered abnormal

2019-09-14T15:17:46Z

Differential Diagnosis

2019-09-14T14:02:10Z

← Older revision		Revision as of 14:02, 14 September 2019
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	*[[Malignant hypertension]]		*[[Malignant hypertension]]
	*[[Idiopathic intracranial hypertension]] (pseudotumor cerebri)		*[[Idiopathic intracranial hypertension]] (pseudotumor cerebri)
	*Intracranial mass		*[[Intracranial mass]]
	*Hydrocephalus		*[[Hydrocephalus]]
	*Cerebral edema		*Cerebral edema

	==Clinical Features==		==Clinical Features==
	*Increased ICP symptoms:		*[[Increased ICP]] symptoms:
	**[[Headache]] (esp with recumbency and in the morning)		**[[Headache]] (esp with recumbency and in the morning)
	**[[Nausea and vomiting]]		**[[Nausea and vomiting]]
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	**May have visual obscurations that clear completely lasting seconds		**May have visual obscurations that clear completely lasting seconds

	~~==Differential Diagnosis==~~

	~~==Evaluation==~~
	===Fundoscopy===		===Fundoscopy===
	*Loss of spontaneous venous pulsations		*Loss of spontaneous venous pulsations
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	*Cup is diminished or absent		*Cup is diminished or absent

	===~~Work-Up~~===		==Differential Diagnosis==
			*[[Malignant hypertension]]
			*[[Idiopathic intracranial hypertension]] (pseudotumor cerebri)
			*[[Intracranial mass]]
			*[[Hydrocephalus]]
			*Cerebral edema

			==Evaluation==
	*MRI		*MRI
	*CT (if MRI unavailable)		*CT (if MRI unavailable)
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	==See Also==		==See Also==
			*[[Increased ICP]]

	==External Links==		==External Links==
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	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]
	[[Category:Neurology]]		[[Category:Neurology]]
			[[Category:Symptoms]]

2017-07-24T01:13:00Z

Text replacement - "==References== " to "==References== <references/> "