The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Abstract

Purpose To determine the sensitivity and specificity of orbital ultrasonography in distinguishing papilledema from pseudopapilledema in adult patients. Methods The records of all adult patients referred to the neuro-ophthalmology service who underwent orbital ultrasonography for the evaluation of suspected papilledema were reviewed. The details of history, ophthalmologic examination, and results of ancillary testing including orbital ultrasonography, MRI, and lumbar puncture were recorded. Results of orbital ultrasonography were correlated with the final diagnosis of papilledema or pseudopapilledema on the basis of the clinical impression of the neuro-ophthalmologist. Ultrasound was considered positive when the optic nerve sheath diameter was Z3.3 mm along with a positive 301 test. Results The sensitivity of orbital ultrasonography for detection of papilledema was 90% (CI: 80.2-99.3%) and the specificity in detecting pseudopapilledema was 79% (CI: 67.7-90.7%). Conclusions Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive, but less specific in differentiating papilledema from pseudopapilledema in adult patients, and can be useful in guiding further management of patients in whom the diagnosis is initially uncertain.

Use of A-scan Ultrasound and Optical Coherence Tomography to Differentiate Papilledema From Pseudopapilledema

“…Compared to Carter et al 8 where 67% of pseudopapilledema patients were asymptomatic, every pseudopapilledema patient presented with at least one symptom, which was what warranted the referral. Our neuro-ophthalmologist was fully aware that idiopathic intracranial hypertension can occur without papilledema, 38 therefore, careful analysis of clinical history, symptomology, and when necessary, further testing, communication with referring neurologists, and observation over time were conducted to minimize false negatives.…”

“…7, 8 Carter et al 8 defined abnormal ultrasound using optic nerve sheath diameter (> 3.3 mm) and 30° test (>10%), reporting a 79% specificity; while Neudorfer et al 7 only used optic nerve sheath diameter (> 3.3 mm), reporting 63% specificity. If we used > 10% as a criterion, the 30° test had 91.3%/85.7% sensitivity/specificity.…”

Diagnostic Ophthalmic Ultrasound for Radiologists

“…The ONSD, measured as the distance between the 2 arachnoid sheath spikes (vertical arrows), is 5.74 mm at primary gaze (left side) and decreases to 4.11 mm at lateral gaze (right side). Carter and colleagues 19 and a retrospective study from the authors' own clinic (data to be published) showed that ONSD combined with the 30 test is sensitive in differentiating papilledema from pseudopapilledema, such as optic nerve drusen, hyperopic disc, or titled optic nerve head (Fig. 51).…”

The cost-effectiveness of different strategies to evaluate optic disk drusen in children

“…5 Although detection of ODD with ultrasound B-scan is well established, the detection of true papilledema is also possible, by measuring optic nerve sheath diameter, 6 with a sensitivity of 90% to detect papilledema and a specificity of 79% to detect pseudopapilledema in adult patients. 7 To determine the prevalence of ODD and true papilledema in children referred for apparent optic nerve head swelling we retrospectively reviewed the medical records of children #16 years of age presenting to Moorfields Eye Hospital NHS Foundation Trust, London, over a 2-year period (2008-2009) with optic disk swelling and in whom ODD had been demonstrated on ultrasonography (performed by a single experienced ultrasonographer [MR]). In 22 of 39 children an isolated diagnosis of ODD was established, based on clinical examination and, where indicated, ancillary tests, including neuroimaging (CT or MRI) in 3 patients and visual electrophysiology testing in one.…”