Papilloedema presentation1

papilloedema

1. PAPILLOEDEMA

2. P apilloedem a 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

5. Circulation of CSF Fluid

6. Causes of raised ICP Idiopathic intracranial HTN. Obstruction of ventricular system. Space occupying intracranial lesions. Impairment of CSF absorption.

7. Cerebral venous sinus thrombosis . Cerebral oedema from blunt head trauma . Severe systemic HTN. Hypersecretion of CSF Causes of raised ICP

8. Causes of raised ICP

9. Causes of optic disc elevation 1.Papilloedema 2. Accelerated hypertension 3. Anterior optic neuropathy - Ischaemia - Inflammatory - Infiltrative - Compressive

10. 4. Pseudopapilloedema - Optic disc drusen - Tilted optic disc - Peripapillary myelinated nerve fibres - Crowded disc in hypermetropia 5. Mitochondrial optic neuropathy - Leber hereditary optic neuropathy - Methanol poisoning

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

15. Papilloedema . ( Early)

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

17. Papilloedema .- acute 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

19. Papilloedema .-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)

21. Papilloedema - atrophic

22. Investigations B-scan ultrasonography CT scan of brain MRI of Brain Venography Lumbar puncture

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

24. Treatment Shunt technique Ventriculoperitoneal shunt Lumboperitoneal shunt Ventriculoarterial shunt

25. Complication Visual loss. Chronic headche . Complication related to lumbar puncture. Complication related to shunt.

26. Thanks to all