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12/13/13

Papilledema

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Papilledema
Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy Sr, MD more... Updated: Feb 15, 2012

Background
Papilledema is an optic disc swelling that is secondary to elevated intracranial pressure.[1, 2] In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema. Papilledema almost always presents as a bilateral phenomenon and may develop over hours to weeks. The term, as a matter of definition, is incorrect to be used to describe optic disc swelling with underlying optic nerve infectious, infiltrative, or inflammatory etiologies; but, it is correctly used if the underlying cause of elevated intracranial pressure is infectious, infiltrative, or inflammatory.

Pathophysiology
The disc swelling in papilledema is the result of axoplasmic flow stasis with intra-axonal edema in the area of the optic disc.[3] The subarachnoid space of the brain is continuous with the optic nerve sheath. Hence, as the cerebrospinal fluid (CSF) pressure increases, the pressure is transmitted to the optic nerve, and the optic nerve sheath acts as a tourniquet to impede axoplasmic transport. This leads to a buildup of material at the level of the lamina cribrosa, resulting in the characteristic swelling of the nerve head. Papilledema may be absent in cases of prior optic atrophy. In these cases, the absence of papilledema is most likely secondary to a decrease in the number of physiologically active nerve fibers.

Epidemiology
Frequency
United States Rare International Rare

Mortality/Morbidity
Early detection and identification of cause may be life saving.

Race
No racial predilection exists.

Sex
Papilledema affects both sexes equally.

Age
Papilledema can present at any age, though, during infancy, before the fontanelles close, the finding of
emedicine.medscape.com/article/1217204-overview 1/3

Joplin. Minnesota Medical Association. American Society of Cataract and Refractive Surgery. American College of Surgeons. David Grant Medical Center. Specialty Editor Board Edsel Ing. University of California. MD Professor of Ophthalmology. Department of Ophthalmology. PharmD Clinical Professor of Health Sciences. OD.medscape. American Association for Pediatric Ophthalmology and Strabismus. University of Toronto Faculty of Medicine. University of Minnesota Medical School Mitchell V Gossman. MD. Eye Surgeons and Physicians. MD Clinical Professor. Simon K Law. and North American Neuro-Ophthalmology Society Disclosure: Nothing to disclose. MD. Mayo Clinic School of Medicine Brian R Younge. and Pan-American Association of Ophthalmology Disclosure: Nothing to disclose. MD. Jules Stein Eye Institute. FRCSC is a member of the following medical societies: American Academy of Ophthalmology. and Association for Research in Vision and Ophthalmology Disclosure: Nothing to disclose. PA. MD. emedicine. and Royal College of Physicians and Surgeons of Canada Disclosure: Nothing to disclose. Georgetown University Medical Center Disclosure: Nothing to disclose. MD Chief of Ophthalmology. FRCSC Associate Professor. Medical Director. PharmD is a member of the following medical societies: American Academy of Ophthalmology.12/13/13 Papilledema papilledema may fail to occur despite elevated intracranial pressure. Travis Air Force Base Joseph Giovannini. Canada Edsel Ing. Coauthor(s) Joseph Giovannini. MD Associate Clinical Professor. David Geffen School of Medicine Simon K Law. Eye Surgery Center. and Phi Beta Kappa Disclosure: Nothing to disclose. Additional Contributors Georgia Chrousos. University of Arkansas for Medical Sciences Hampton Roy Sr. Consulting Staff. Missouri Disclosure: Nothing to disclose. Department of Ophthalmology. Contributor Information and Disclosures Author Mitchell V Gossman. Department of Ophthalmology and Vision Sciences. Los Angeles. American Glaucoma Society. MD Ophthalmologist. Affiliated With Freeman Hospital and St John's Hospital. Central Minnesota Surgical Center. MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery Disclosure: Nothing to disclose. Toronto East General Hospital. Lance L Brown. MD is a member of the following medical societies: Alpha Omega Alpha. American Medical Association. Brian R Younge. American Ophthalmological Society. Canadian Ophthalmological Society. Chief Editor Hampton Roy Sr. American Academy of Ophthalmology. North American Neuro-Ophthalmology Society.com/article/1217204-overview 2/3 . Division of Neuro-Ophthalmology and Pediatric Ophthalmology Services. American Society of Ophthalmic Plastic and Reconstructive Surgery. MD is a member of the following medical societies: American Medical Association. North American Neuro-Ophthalmology Society. MD Partner and Vice President. Department of Ophthalmology. Regional Eye Center. Clinical Associate Professor. MD is a member of the following medical societies: American Academy of Ophthalmology.

Nightingale PG. Lippincott Williams & Wilkins. LLC Ads not by this site Ads not by this site emedicine.4. Mathews MK. 5. Vaphiades MS. 6. Resolution of pseudotumor cerebri after bariatric surgery for related obesity. 7. Matthews TD. Baltimore. Butler IJ. Koenig MK. [Medline]. Incidence of papilledema and obesity in children diagnosed with idiopathic 'benign' intracranial hypertension: case series and review.com/article/1217204-overview 3/3 . Yanoff M. et al. Ophthalmology Monographs. Surv Ophthalmol. Case report. Burdon MA. American Academy of Ophthalmology.14(6):36470. Papilledema. 1996. Scott CJ. Nov 2010. Sanders MD. Lawden M. Nov 2004. Kardon RH. 10. Ophthalmology. Frisén L. Lee AG. 1997:78-84. Jacks A. Curr Opin Ophthalmol. Jan 12 2012.12/13/13 Papilledema References 1. 1999:11. Savino PJ. [Full Text]. Newman NJ. et al. Jun 2010. Optic Nerve Disorders. J Neurosurg. Medscape Reference © 2011 WebMD. Sergott RC. Kline LB.medscape. Wallace D. eds. Sinclair AJ. Mar-Apr 2002.47(2):183-8. 8. Ehlers JP. Common Problems in Neuro-ophthalmology. 3. Pseudotumor cerebri. Walsh & Hoyt's Clinical Neuro-ophthalmology: The Essentials . Miller NR. J Neurol. 11. Md: Lippincott Williams & Wilkins. Dec 2003. Nadkarni T. Rating papilloedema: an evaluation of the Frisén classification in idiopathic intracranial hypertension.1-5. Arch Ophthalmol. eds. [Medline]. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. J Child Neurol. 2008:252-254.25(11):1389-92. 2008:122-145. Rekate HL. [Medline]. 9. Shah CP. Duker JS. 2. Diagnosis and grading of papilledema in patients with raised intracranial pressure using optical coherence tomography vs clinical expert assessment using a clinical staging scale. The disk edema dilemma.5. 4.128(6):705-11. [Medline].101(5):878-80. Wall M.37-53. 5th ed. 2nd ed. Faz G. [Medline]. [Medline]. Acheson JF.