2. Papilloedema
It is swelling of optic nerve head due to
raised ICP .
It is nearly always bilateral.
All patient with papilloedema should be
suspected of having intracranial mass.
3. Production of CSF
CSF is formed by Choroid plexus in
the ventricles of the brain .
Normal CSF pressure 10-18 cm H2O
4. Circulation of CSF Fluid
Lateral ventricle Lateral ventricle
Foramina
of Munro
Third ventricle
Fourth ventricle
Sylvian
aqueduct
Sub arachnoid
space
Foramina of
Luschka and
Megendie
Cerebral venous
system
Absorption
Via Arachnoid
villi
11. 6. Intra ocular disease
- Central retinal vein occlusion
- uveitis
- Posterior scleritis
- Hypotony
12. Clinical features of raised ICP
Headache
Nausea
Deterioration of consciousness .
Visual symptoms :
- Transient obscurations
-Horizontal diplopia
-Vision reduction
13. Fig.Mechanism of sixth nerve palsy due to raised
intracranial pressure
Dilated ventricles
Petrous tip
Brainstem pushed downwards
14. Stages of papilloedema
• Optic disc show mild hyperaemia
with preservation of the optic cup.
• Indistinct peripapillary retinal
nerve striations and disc margins.
Early stage
16. • VA is normal or reduced .
• Optic disc shows severe hyperaemia ,
moderate elevation with indistinct margin
and absence of the physiological cup.
• Venous engorgement , peripapillary flame
shaped hemorrhage ,frequently cotton
wool spots .
• Macular fan
• Blind spot is enlarged.
Established
18. • VA is variable and visual fields begin to
constrict
• Optic disc is not elevated
• Cotton wool spots and hemorrhages are absent
• Opto-cilliary shunt and drusen like crystalline
deposits may be present on the disc surface .
Chronic
20. • VA is severely impaired .
• The optic discs are grey-white , slightly
elevated with few crossing blood vessels
and indistinct margin.
Atrophic (Secondary optic atrophy)
23. Treatment
According to cause .
Neuro-surgical consultation .
Method of reducing ICP
Mannitol infusion
CSF withdrawal
Sedative –propofol, barbiturate
Control hyperventilation
Decompressive craniotomy
Removal of mass lesion if present
Hypothermia
Steriods