Papillodema

Question 1

What is a papiloedema?

Answer 1

swollen disc secondary to raised intracranial pressure

Question 2

What must be ruled out when a patient presents with disc swelling and raised intracranial pressure?

Answer 2

space occupying lesion

Question 3

How is a papilloedema diagnosed?

Answer 3

ophthalmoscopy
colour vision
visual fields
visual acuity
pupil exam

Question 4

What is the pathophysiology behind papilloedema?

Answer 4

subarachnoid space is continuous around the optic nerve and into the brain, when intracranial pressure increases in the brain, this is then transferred around the optic nerve which causes interruption of axoplasmic flow and venous congestion leading to swollen discs

Question 5

What is the Monro-Kellie hypothesis?

Answer 5

because the skull is a fixed space, an increase in one of the components (Brain 80%, blood 10% or CSF 10%) must result in a decrease in one of the other components

Question 6

What can increase in volume in the brain lead to?

Answer 6

blood vessel compression causing global brain ischeamia and swelling with hernitation through the foramen magnum

Question 7

What can cause papilloedema?

Answer 7

tumours
malignant hypertension
overproduction of CSF
obstruction of CSF circulation
inadequate CSF absorbtion
idiopathic intracranial hypertension

Question 8

What is idiopathic intracranial hypertension due to?

Answer 8

not fully understood
may be due to things that obstruct CSF circulation:
stenosis of the transvere cerebral sinuses
increased abdo pressure in obese patients
OR due to things that blocks CSF absorption:
vitamin A
microemboli in sagittal sinus