2. Introduction
Common cause of disc swelling.
Most common cause of papillodema.
NB because papilloedema can = mass lesion.
NB because IIH can lead to significant visual
loss.
3. Modified Dandy Criteria
Signs and symptoms of raised intracranial
pressure
Normal neuro exam, except 6th
nerve palsy
Elevated CSF pressure with normal
constituents
Normal neuroimaging
4. Demographics and General Info
Typical = early adult, women, overweight or
recent weight gain.
Cause and mechanism unclear (? decreased
CSF absorption from dysfunctional arachnoid
villi). Numerous other postulations.
5. Clinical Presentation
Headache.
– 90% of patients (most common).
– 60% pulsatile intracranial noise.
Visual symptoms.
– Transient visual obscurations (TVOs), 72%.
– Blurred vision.
– Enlarged blind spot or other visual field loss.
– Diplopia.
6. Associated Conditions
Before examination, think!?
Very long list of conditions to consider in the
differential diagnosis.
Need to exclude cranial venous conditions,
mass lesions and specific known causes of
elevated intracranial pressure.
7. Venous thrombosis or obstruction.
– Pseudotumor like appearance, difficult to exclude.
– Cerebral dural venous sinus thrombosis > increased
venous pressure >decreased CSF absorbtion.
– Seriously effected patients develop cortical vein
thrombosis and cerebral infarction.
– Also thrombosis of transverse and sigmoid sinus.
– Cause of clot formation:
9. Neuro-ophthalmic Examination
– Insidious visual or field loss.
– Sever loss (chronic papilloedema, RD, Hx, macular
exudate).
– Peripheral field defects, enlarged blind spot.
– Colour and pupil normal.
– 50% abnormal contrast sensitivity.
– 6th
nerve palsy.
10. Papilloedema
– Usually bilatereal
– Pantons lines
– Vascular changes (2nd
to compression)
– Loss of spontaneous venous pulsation
– Acute vs chronic
11. Pseudopapilloedema
– Congenital, harmatoma, mylinated nerve fibers,
drusen
– Serial examinations
– Optic disc drusen
Defect in axonal metabolism
1-2% of population, often bilat, inherited
Examination, u/s, CT
– Other causes
12. Diagnostic Evaluation
MRI better than CT
– Empty sella, dilation optic nerve sheath, flat post
globe, elevation of optic disc, slit like ventricles
LP
– >25mm H20
13. Management
No visual loss
– Weight reduction
– Acetazolamide (500-2000 mg/day)
Mild to moderate visual loss
– Acetazolamide (up to 2-3 gms/day)
– Or furosemide (40-80mg daily)
– Weight reduction
14. Sever or progressive visual loss.
– Optic nerve sheath fenestration.
– High-dose IV steroids and acetazolamide.
– Lumboperitoneal shunt for failed ONSF or
intractable headache.
15. Outcome
Mild and moderate do well
Sever can have decreased vision and field
defects. Devestating 5%
