Papilledema is relatively uncommon in infants due to the lack of fusion of skull bones. We report a rare case of ocular cysticercosis with multiple disseminated subcutaneous nodules on the body with bilateral papilledema with multiple calcified cysts with scolex in brain parenchyma and cerebellum on computed tomography ct scan. Any reported unilateral papilledema should be viewed skeptically and is more likely optic disc edema. Pdf papilledema is a rare but recognized complication of. Based on the findings of severe bilateral papilledema in the context of elevated csf pressure, endstage renal disease, hyperostosis of the skull, and the otherwisenegative results of workup, the cause of the patients papilledema was bilateral jugular foraminal stenosis most likely secondary to renal osteodystrophy. Ocular cysticercosis is a disease which rarely involves. Epidemiology, etiology, and clinical management article pdf available in eye and brain 7default. Papilledema almost always presents as a bilateral phenomenon and may develop over hours to weeks. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Evaluation and treatment of papilledema in pregnancy. Overview and differential diagnosis of papilledema uptodate. Papilledema and obstructive sleep apnea syndrome neuro. In addition to bilateral hyperemic and swollen optic disks optic nerve heads, patients typically have engorged and tortuous retinal veins, and retinal hemorrhages around the disk but not into the retinal. Unilateral or bilateral optic disc swelling requires the clinician to obtain a thorough history and perform a detailed general, neurologic, and ophthalmologic exam to develop a broad differential diagnosis. Csf is produced by the choroid plexus in the lateral ventricles, and absorbed. Papilledema is swelling of your optic nerve, which connects the eye and brain. Funduscopy revealed severe bilateral papilledema figure 1. Papilledema refers to optic disc swelling from raised intracranial pressure. Papilledema genetic and rare diseases information center.
Bilateral papilledema secondary to obstructive or communicating hydrocephalus in patients with vestibular schwannomas is a known presentation. The eye fundus examination revealed bilateral papilloedema with a haemorrhagic component, predominantly in the left eye fig. Papilledema, strictly defined, refers to optic nerve swelling typically bilateral for the test think of it this way associated with increased intracranial pressure. The increased csf pressure is transmitted to the optic nerve, resulting in stasis of axoplasmic flow causing. She was overweight and had a body mass index bmi of 32 kgm 2. There were no postural variation in symptom intensity, pulsatile tinnitus or additional neurological symptoms. Bilateral blurred disc margins in the left optic nerves. Treponema pallidum is known as the great masquerader for its many presentations and ocular findings in patients who are infected and develop secondary and tertiary stage of syphilis. Papilledema bilateral blurred disc margins in the right optic nerve. Pdf evaluation and treatment of papilledema in pregnancy. Pdf papilledema is optic disc swelling due to high intracranial pressure. Information concerning such a condition is abundant in neurological and neurosurgical journals, but relatively little has been written in the ophthalmological literature. A twelveyearold girl with osteogenesis imperfecta was referred to our clinic. Papilledema differential diagnoses medscape reference.
Primary spinal melanoma with bilateral papilledema. In the preantibiotic era this condition was a wellknown complication of head and neck infection. The diagnostic challenge of evaluating papilledema in the pediatric. Papilledema definition, pictures, causes, symptoms, treatment.
Bilateral papilledema elevated disc with obscuration of blood vessels and pripapillary hge which is long standind not acute. Bilateral papilledema and partially empty sella in a woman. These files will have pdf in brackets along with the filesize of the download. To diagnose papilledema, a doctor uses an ophthalmoscope a light with magnifying lenses that is used to look into the back of the eye. The reported occurrence of papilledema in patients with cvt is about 25%75% in the literature and it is bilateral. The ophthalmologist is frequently called upon to evaluate a case in which bilateral papilledema is the only finding.
Papilledema is a condition in which increased pressure in or around the brain intracranial pressure. Papilledema is nearly always bilateral, is accompanied by loss of venous pulsations, and varies in appearance from mild to severe fig. Methods a series of 4 patients with sas and papilledema pe underwent complete neuroophthalmologic evaluation and lumbar puncture. The etiology for the high icp or intracranial hypertension. Bilateral papilledema and selfmutilation jama neurology. Papilledema eye disorders msd manual professional edition. To present a female child patient with osteogenesis imperfecta who had bilateral papilledema. This range of appearances can be described by using the frisen scale table 245.
It usually happens bilateral which means it happens in both eyes. While the term papilledema is often used broadly to denote a swollen optic nerve head, the term papilledema should be reserved for optic disc swelling that is due to raised intracranial pressure. Often an ophthalmologist a medical doctor who specializes in the evaluation and treatment of eye disorders needs to confirm the diagnosis and help determine the cause. Papilledema is clinically defined as optic disc swelling secondary to increased intracranial pressure icp. Presentation and progression of papilledema in venous. Bilateral haemorrhagic papilloedema secondary to carboplatin use. For language access assistance, contact the ncats public information officer. Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause.
Children, intracranial hypertension, optic disc drusen. International license, which allows users to download, copy and build. A recent ct scan of the head arranged by his general. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed. Syphilitic ocular manifestations include uveitis, chorioretinitis, retinitis, vasculitis, vitritis, and panuveitis all with or without decreased visual acuity. We report a case with primary hypocalcaemia who presented with bilateral cataract with papilledema as the first clinical. Longterm complications of chronic hypocalcaemia like bilateral cataract, papilledema and basal ganglia calcification are rare. Bilateral papilledema secondary to systemic tetracycline use. Bilateral papilledema in otherwise well patients jama. Papilledema on the other hand, is the bulging or swelling of the optic disc. Papilledema is frequently bilateral and symmetric, but may be asymmetric or unilateral. Bilateral best corrected visual acuity of the patient was 510 corrected with.
Papilledema is defined as optic disc edema caused by elevated intracranial pressure icp and should be distinguished from papillitis. This topic will provide an overview and differential diagnosis of papilledema. If you have problems viewing pdf files, download the latest version of adobe reader. Csf from a lumbar puncture at the l4l5 level was xanthochromic with an elevated protein level 4,350 mgdl.
The presence of bilateral papilledema usually rules out possible problems specific to the eyes that may cause swelling. The usual clinical presentation of ventriculoperitoneal valve dysfunction in children with full cranial development includes headache, vomiting, nausea and lethargy. Papilledema is most often bilateral, but may be asymmetrical. Syphilisrelated eye disease presenting as bilateral. A young adult male was referred by his optometrist for suspected papilloedema. What is the differential diagnosis for papilledema in a patient of this age group. Papilledema definition, pictures, causes, symptoms. We report a case with primary hypocalcaemia who presented with bilateral cataract with papilledema as the first clinical manifestation. It is considered an emergency because intracranial pressure may rise in an exponential fashion with the potential for acute neurologic decompensation. In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema. Papilledema eye disorders merck manuals professional.
Papilledema eye disorders msd manual consumer version. Swelling of the optic nerve in papilledema is most often bilateral and. Spontaneous internal jugular vein thrombosis is a rare vascular disorder. Cureus vestibular schwannoma presenting with bilateral. Bilateral optic disc swelling for dd optic disc swelling. He complained of a 4week history of intermittent headache and a 2day history of blurred vision in his right eye. Papilledema is a rare but recognized complication of hypocalcaemia with primary or surgically induced hypoparathyroidism. A woman, aged 21 years, presented to her general practitioner with a 1month history of severe headaches. This swelling is a reaction to a buildup of pressure in or around your brain that may have many causes often, its.
A 61yearold man presented with a 4month history of progressive vision loss and paresthesia between the right l2l4 dermatome. Presentation and progression of papilledema in venous sinus thrombosis katy c. Papilledema can happen over a time frame of hours to weeks. A woman in her 30s was referred for evaluation of bilateral papilledema and progressive visual loss in the right eye, which deteriorated to blindness in 3 months. Bilateral papilledema american academy of ophthalmology. Ophthalmoscopy showed bilateral papilledema with normal visual acuity. Ophthalmologic examination was consistent with bilateral papilledema.
Pdf bilateral papilledema in hypocalcemia researchgate. Pdf bilateral papilledema in chiari i malformation. Papilledema is swelling of the optic nerves that occurs in response to increased pressure in the head i. We report a case of a 20yearold woman presenting with visual deterioration and bilateral papilledema on. The elevated pressure in the head pushes on the optic nerve. On further questioning she reported intermittent episodes of blurred vision.
This is a condition that can be found in all age groups but it is fairly uncommon to find it in infants because the bones of their skulls are not fully fused together yet. She denied any other neurologic symptoms, such as headache, nausea, vomiting, seizures, and paresis. Most cases of papilledema are bilateral, although the optic nerve appearance can be asymmetric. The optic nerve carries images from your eye to your brain. We also describe the clinical evaluation once a diagnosis of papilledema has been established. To open a pdf file you will need compatible software. Differentiating papilledema from other causes of a swollen optic disk, such as optic neuritis, ischemic optic neuropathy, hypotony, central retinal vein occlusion, uveitis, or pseudo swollen disks eg, optic nerve drusen, requires a thorough ophthalmologic evaluation.
Eldairi1 departments of ophthalmology,1 neurology2 and neurosurgery,3 duke eye center and duke university medical center, durham, nc. Bilateral papilledema in a child with osteogenesis imperfecta. The swelling is usually bilateral and can occur over a period of hours to weeks. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed tomography ct. Unilateral papilledema in cerebral venous sinus thrombosis. Disseminated neurocysticercosis with bilateral papilledema. A 12 yearold girl patient with a history of ventriculoperitoneal shunt placement at the age of 6 months presented with progressive bilateral decrease in visual acuity. Peripapillary choroidal neovascularization as an unusual. Papilledema is an optic disc swelling that is secondary to elevated intracranial pressure. Objectives to characterize the pathogenesis and clinical features of optic disc edema associated with obstructive sleep apnea syndrome sas.