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 Papilledema

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امير الطب
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تاريخ التسجيل : 17/06/2009

مُساهمةموضوع: Papilledema   الأحد 21 يونيو - 9:06

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Papilledema



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.

Signs and symptoms


Papilledema may be asymptomatic in the early stages. However it may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision.
The signs of papilledema that are seen using an ophthalmoscope include



  • venous engorgement (usually the first signs)
  • loss of venous pulsation
  • hemorrhages over and / or adjacent to the optic disc
  • blurring of optic margins
  • elevation of optic disc
  • Paton's lines = radial retinal lines cascading from the optic disc

On visual field examination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged.












Diagnosis

Checking the eyes for signs of papilledema should be carried out whenever there is a clinical suspicion of raised intracranial pressure, and is recommended in newly onset headaches. This may be done by ophthalmoscopy or slit lamp examination.


Causes



  • Raised intracranial pressure: brain tumor, pseudotumor cerebri or cerebral venous sinus thrombosis, Intracerebral hemorrhage
  • Respiratory failure[1]
  • Hypotonia
  • Accutane (Isotretinoin), which is a powerful derivative of Vitamin A, rarely causes Papilledema.
  • Guillain-Barré syndrome due to elevated protein levels
  • Foster Kennedy syndrome (FKS)
  • Chiari Malformation
  • Tumors of the frontal lobe
  • Acute Mountain Sickness and High Altitude Cerebral Oedema


Pathophysiology

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.


Treatment

The treatment depends largely on the underlying cause. For instance, raised intracranial pressure may improve with glucocorticoids, acetazolamide or surgical shunting.






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عدد المساهمات : 635
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تاريخ التسجيل : 07/06/2009

مُساهمةموضوع: رد: Papilledema   الإثنين 22 يونيو - 3:13

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عدد المساهمات : 242
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تاريخ التسجيل : 08/05/2009

مُساهمةموضوع: رد: Papilledema   الأربعاء 1 يوليو - 21:43


_________________
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Papilledema
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