tailieunhanh - Chapter 029. Disorders of the Eye (Part 12)

Papilledema This connotes bilateral optic disc swelling from raised intracranial pressure (Fig. 29-12). Headache is a frequent, but not invariable, accompaniment. All other forms of optic disc swelling, ., from optic neuritis or ischemic optic neuropathy, should be called "optic disc edema." This convention is arbitrary but serves to avoid confusion. Often it is difficult to differentiate papilledema from other forms of optic disc edema by fundus examination alone. Transient visual obscurations are a classic symptom of papilledema. They can occur in only one eye or simultaneously in both eyes. They usually last seconds but can persist longer. Obscurations. | Chapter 029. Disorders of the Eye Part 12 Papilledema This connotes bilateral optic disc swelling from raised intracranial pressure Fig. 29-12 . Headache is a frequent but not invariable accompaniment. All other forms of optic disc swelling . from optic neuritis or ischemic optic neuropathy should be called optic disc edema. This convention is arbitrary but serves to avoid confusion. Often it is difficult to differentiate papilledema from other forms of optic disc edema by fundus examination alone. Transient visual obscurations are a classic symptom of papilledema. They can occur in only one eye or simultaneously in both eyes. They usually last seconds but can persist longer. Obscurations follow abrupt shifts in posture or happen spontaneously. When obscurations are prolonged or spontaneous the papilledema is more threatening. Visual acuity is not affected by papilledema unless the papilledema is severe long-standing or accompanied by macular edema and hemorrhage. Visual field testing shows enlarged blind spots and peripheral constriction Fig. 29-3F . With unremitting papilledema peripheral visual field loss progresses in an insidious fashion while the optic nerve develops atrophy. In this setting reduction of optic disc swelling is an ominous sign of a dying nerve rather than an encouraging indication of resolving papilledema. Figure 29-12 Souk f uo AS. h p rOL. brturnald f SL. Longo OL. Itmtfon JL. Lotctlco Ji MiflrfrojT r Ajfttÿhïij of Internet Mh khh Edition http i uvw. cc irm dian . com Copyright a Th McOwHlH gtnp nitt Inc. Ait right Papilledema means optic disc edema from raised intracranial pressure. This obese young woman with pseudotumor cerebri was misdiagnosed as a migraineur until fundus examination was performed showing optic disc elevation hemorrhages and cotton-wool spots. Evaluation of papilledema requires neuroimaging to exclude an intracranial lesion. MR angiography is appropriate in selected cases to search for a dural venous sinus .