True Papilloedema

Papilloedema is swelling of the optic discs because of increased intracranial pressure. Every doctor must be aware of the triad of headache, papilloedema and vomiting as an important feature of raised intracranial pressure. The optic disc might be markedly swollen and haemorrhages are present around it,but not usually in the peripheral fundus (Figure 22.4). In chronic papilloedema, the disc is paler and haemorrhages might be few or absent. Although these patients might complain of transient blurring of the vision, the visual acuity is usually normal and testing the visual fields shows only some enlargement of the blind spots. It is important to realise that the word "papilloe-

dema"refers to the noninflammatory swelling of the disc, which results from raised intracranial pressure. The most common causes of raised intracranial pressure are cerebral tumours, hydrocephalus idiopathic (benign) intracranial hypertension, subdural haematoma, malignant hypertension and cerebral abscess.

Diagnosis of papilloedema entails careful examination of the optic disc, which must be backed up with visual field examination and colour fundus photography. The latter is especially helpful when repeated,to show any change in the disc appearance. Fluorescein angiography can also be of great diagnostic help in difficult cases when abnormal disc leakage occurs.

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