PAPILLOEDEMA

Papilloedema

 It is swelling of optic nerve head due to

raised ICP .
 It is nearly always bilateral.
 All patient with papilloedema should be
suspected of having intracranial mass.
 Production of CSF

CSF is formed by Choroid plexus in

the ventricles of the brain .
Normal CSF pressure 10-18 cm H2O
 Circulation of CSF Fluid

Lateral ventricle Lateral ventricle

Foramina
of Munro

Third ventricle

Sylvian
aqueduct

Foramina of Fourth ventricle

Luschka and
Megendie

Sub arachnoid Absorption Cerebral venous

space Via Arachnoid system
villi
Circulation of CSF Fluid
 Causes of raised ICP
 Idiopathic intracranial HTN.
 Obstruction of ventricular system.
 Space occupying intracranial lesions.
 Impairment of CSF absorption.
 Causes of raised ICP

Cerebral venous sinus thrombosis .

 Cerebral oedema from blunt head
trauma .
Severe systemic HTN.
Hypersecretion of CSF
Causes of raised ICP
Causes of optic disc elevation

1.Papilloedema
2. Accelerated hypertension
3. Anterior optic neuropathy
- Ischaemia
- Inflammatory
- Infiltrative
- Compressive
4. Pseudopapilloedema
- Optic disc drusen
- Tilted optic disc
- Peripapillary myelinated nerve fibres
- Crowded disc in hypermetropia
5. Mitochondrial optic neuropathy
- Leber hereditary optic neuropathy
- Methanol poisoning
6. Intra ocular disease
- Central retinal vein occlusion
- uveitis
- Posterior scleritis
- Hypotony
Clinical features of raised ICP
 Headache
 Nausea
 Deterioration of consciousness .
 Visual symptoms :
- Transient obscurations
-Horizontal diplopia
-Vision reduction
 Dilated ventricles

Petrous tip

Brainstem pushed downwards

Fig.Mechanism of sixth nerve palsy due to raised

intracranial pressure
 Stages of papilloedema

Early stage
• Optic disc show mild hyperaemia
with preservation of the optic cup.
• Indistinct peripapillary retinal
nerve striations and disc margins.
Papilloedema. ( Early)
 Established
• VA is normal or reduced .
• Optic disc shows severe hyperaemia ,
moderate elevation with indistinct margin
and absence of the physiological cup.
• Venous engorgement , peripapillary flame
shaped hemorrhage ,frequently cotton
wool spots .
• Macular fan
• Blind spot is enlarged.
Papilloedema.- acute established
 Chronic
• VA is variable and visual fields begin to
constrict
• Optic disc is not elevated
• Cotton wool spots and hemorrhages are absent
• Opto-cilliary shunt and drusen like crystalline
deposits may be present on the disc surface .
Papilloedema.-chronic
Atrophic (Secondary optic atrophy)

• VA is severely impaired .

• The optic discs are grey-white , slightly

elevated with few crossing blood vessels

and indistinct margin.

Papilloedema- atrophic
 Investigations

 B-scan ultrasonography
 CT scan of brain
 MRI of Brain
 Venography
 Lumbar puncture
 Treatment

 According to cause .
 Neuro-surgical consultation .
 Method of reducing ICP
Mannitol infusion
CSF withdrawal
Sedative –propofol, barbiturate
Control hyperventilation
Decompressive craniotomy
Removal of mass lesion if present
Hypothermia
Steriods
 Treatment

 Shunt technique
Ventriculoperitoneal shunt
Lumboperitoneal shunt
Ventriculoarterial shunt
 Complication

 Visual loss.
 Chronic headche.
 Complication related to lumbar puncture.
 Complication related to shunt.
Thanks to all