Investigation of choice in papilloedema?

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The incidence of IIH is increasing in line with the global epidemic of obesity. There are controversial issues in its diagnosis and management. This paper gives a practical approach to assessing patients with papilloedema, its investigation and the subsequent management of patients with IIH.

Is there a practical approach to the diagnosis and management of papilloedema?

Papilloedema is a medical emergency and no patient should be discharged from hospital without exclusion of a mass lesion (SOL or venous thrombosis), ie a CT head scan is not sufficient (a CT venogram or MR venogram will need to be performed in addition to the CT or MRI).

Can you be discharged from hospital with papilloedema?

In the absence of papilledema, a definitive diagnosis requires a 6thnerve palsy In the absence of papilledema and a 6thnerve palsy, a suggestive diagnosis requires 3 of 4 neuroimaging findings A diagnosis is deemed “probable” if all other criteria are met but no lumbar puncture is performed to determine opening pressure.

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More about Investigation of choice in papilloedema?

1. Papilledema: epidemiology, etiology, and clinical management

Aug 17, 2015 · In the absence of an evidence-based treatment protocol, ONSF is our procedure of choice for papilledema-related visual loss, but CSF shunting procedures may be necessary, especially if intractable headache due to IH with or without visual loss is the predominant feature. The role of CVS stenting in IIH treatment has yet to be established, but …


2. Papilledema: A review of etiology, pathophysiology, diagnosis, and …

Papilledema is optic nerve head edema secondary to raised intracranial pressure (ICP). It is distinct from other causes of optic disk edema in that visual function is usually normal in the acute phase. … with ventriculoperitoneal shunting being the typical procedure of choice. Keywords: Idiopathic intracranial hypertension; Increased …


3. The diagnostic challenge of evaluating papilledema in the …

Oct 11, 2016 · Introduction. The evaluation of papilledema in a child is a common, but often stressful endeavor for the patient, parents, and ophthalmologist alike, despite the rarity of papilledema in the pediatric population.[] Papilledema, or optic disc swelling due to elevated intracranial pressure (ICP), can represent a harbinger of life-threatening etiologies such as …


5. A practical approach to, diagnosis, assessment and management …

Dec 01, 2014 · Because papilloedema indicates potentially serious underlying disease, the purpose of the visit is to recognise and confirm the presence of papilloedema and arrange appropriate onward investigation. An important issue is that, in the UK, the most junior and inexperienced doctor often assesses the patient first to confirm the clinical finding of …


6. Papilledema – EyeWiki

Papilledema is a term that is exclusively used when a disc swelling is secondary to increased intracranial pressure (ICP). It must be distinguished from optic disc swelling from other causes which is simply termed “optic disc edema”. Papilledema must also be distinguished from pseudo-papilledema such as optic disc drusen. Since the root cause of papilledema is increased …


7. Papilledema- A Ready Reckoner for Postgraduates

In the rest of the cases, MRI is the investigation of choice in papilledema. MR venography is recommended concurrent to the MRI if there are no lesions on the MRI to evaluate for venous sinus obstruction. If neuroimaging shows no structural lesion or hydrocephalus and IIH is suspected, then lumbar puncture is warranted. Accurate opening …


9. Neuro-ophthalmology Questions of the Week: Papilledema

Dec 20, 2017 · Visual loss from papilledema happens with any cause of papilledema. Hence it is very important to look for papilledema in all patients with headache or known hydrocephalus, brain tumor, or meningitis and to provide urgent treatment to prevent visual loss when papilledema is present. Explanation: “ 9.5 Classification and Progression of Papilledema



Guidelines for management of Papilloedema Page 3 of 3 If you are not sure ask – either refer to neurology or else the Eye Hospital for guidance. Papilloedema is a medical emergency and no patient should be discharged from hospital without exclusion of a mass lesion (SOL or venous thrombosis), ie a CT head scan is not


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