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Papilledema Associated with Intracranial Hypertension

A 21-year-old woman presented with a two-month history of gradual loss of vision in both eyes and increasing headaches. A ventriculoperitoneal shunt had been inserted when she was one year old. Funduscopic examination demonstrated marked papilledema, with retinal hemorrhages, retinal edema, and the deposition of exudate in a star formation in the macula of both eyes (Panels A and B). Visual acuity was 20/400 in the right eye and was limited to counting fingers from a distance of 0.6 m (2 ft) in the left eye. Investigation revealed that the shunt was blocked. Repair of the shunt resulted in the normalization of intracranial pressure. Six months later, the retinal hemorrhages and most of the exudate had resolved, but both optic nerves continued to show prominent secondary pallor (Panels C and D). The patients vision was 20/200 in the right eye and 20/400 in the left eye. WILLIAM J. POWER, F.R.C.S.
Royal Victoria Eye and Ear Hospital Dublin 2, Ireland

EDWARD HARRIS, M.D.

Copyright 2001 Massachusetts Medical Society.

Brigham and Womens Hospital Boston, MA 02115

1442 N Engl J Med, Vol. 344, No. 19 May 10, 2001 www.nejm.org
The New England Journal of Medicine Downloaded from nejm.org on July 9, 2013. For personal use only. No other uses without permission. Copyright 2001 Massachusetts Medical Society. All rights reserved.