PAPILLEDEMA

Ask the Following Questions:

1. Is the onset acute or gradual? An acute onset would suggest optic neuritis, hypertensive encephalopathy, cerebral hemorrhage, extradural hematoma, brain abscess, dural sinus thrombosis, meningitis, and subarachnoid hemorrhage. On the other hand, a gradual onset would suggest a space-occupying lesion such as brain tumor, abscess, or subdural hematoma.
2. If the onset is acute, is there coma or focal neurologic signs? Findings of coma or focal neurologic signs should suggest cerebral hemorrhage, extradural hematoma, brain abscess, dural sinus thrombosis, meningitis, and subarachnoid hemorrhage. An acute onset without focal neurologic signs or coma would suggest hypertensive encephalopathy and optic neuritis.
3. If onset is gradual, are there focal neurologic signs? Gradual onset of papilledema with focal neurologic signs suggests a brain tumor, abscess, or subdural hematoma.
4. Is there hypertension? The presence of hypertension and papilledema suggests hypertensive encephalopathy, acute glomerulonephritis, and certain collagen diseases. If there is no hypertension and no focal neurologic signs, then a diagnosis of pseudotumor cerebri or pseudopapilledema should be suspected.

DIAGNOSTIC WORKUP

Regardless of whether there are focal neurologic signs or hypertension, a CT scan or MRI should be done, and a consultation with a neurologist should be made when papilledema is suspected.

If there is significant hypertension and the CT scan or MRI are negative, a hypertensive workup should be done .

With a normal CT scan or MRI and no focal neurologic signs or hypertension, a spinal tap and visual field examination will assist in the diagnosis of pseudotumor cerebri. However, a blood lead level should be done to rule out lead poisoning. Also, the visual field exam may show optic neuritis when the clinical examination was inconclusive.

An ophthalmologist will help diagnose optic neuritis and pseudopapilledema.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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