Unilateral Papilledema in Pseudotumor Cerebri

Brosh, Koby; Strassman, Israel

doi:10.3109/08820538.2013.768677

Cited by 17 publications

(15 citation statements)

References 5 publications

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“…Either high peri-optic CSF pressure or low intraocular pressure cause identical microscopic changes and axonal flow stasis (20). However, our study and others (2,7,13) have shown that asymmetric intraocular pressure, although reported in anecdotal cases (3,5,10), is not the primary mechanism of asymmetric papilledema. Therefore, we believe that, in the absence of optic atrophy (20), asymmetric papilledema is most likely related to asymmetric transmission of the CSF pressure to the lamina cribrosa (21).…”

Section: Discussioncontrasting

confidence: 62%

Asymmetric Papilledema in Idiopathic Intracranial Hypertension

Bidot

Bruce²,

Saindane

et al. 2015

Journal of Neuro-Ophthalmology

108

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Background Very asymmetric papilledema in idiopathic intracranial hypertension (IIH) is rare, and few studies have dealt with this atypical presentation of IIH. Our aim was to describe the clinical and radiologic features of patients with IIH and very asymmetric papilledema. Methods We identified all adult patients from our IIH database with very asymmetric papilledema defined as a ≥2 modified Frisén grade difference between the two eyes. Demographic data and initial symptoms were collected, and all brain imaging studies performed at our institution were reviewed. Results Of the 559 adult patients with definite IIH, 20 (3.6%; 95%CI: 2.3-5.6%) had very asymmetric papilledema at initial evaluation. They were older (39 versus 30 years; p<0.001), had lower cerebrospinal opening pressure (35.5 versus 36 cm of water; p=0.03), and were more likely to be asymptomatic compared to patients with symmetric papilledema (27% versus 3%; p<0.001). Visual fields were worse on the side of the highest-grade papilledema (p=0.02). The bony optic canal was smaller on the side of the lowest-grade edema in all 8 patients (100%) in whom the imaging was sufficient for reliable measurements (p=0.008). Conclusion IIH with very asymmetric papilledema is uncommon. Very asymmetric papilledema may result from differences in size of the bony optic canals, supporting the concept of compartmentation of the peri-optic subarachnoid space.

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Section: Discussioncontrasting

confidence: 62%

Asymmetric Papilledema in Idiopathic Intracranial Hypertension

Bidot

Bruce²,

Saindane

et al. 2015

Journal of Neuro-Ophthalmology

108

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“…This study coincides with study of Brosh K, et al 22 who also found a case of pseudotumor cerebri in this age group having papilledema.…”

Section: Drug Historysupporting

confidence: 77%

“…Observations can be summarized as under:  Most commonly affected age group was between [21][22][23][24][25][26][27][28][29][30] years in which 32% cases.  Least commonly affected age group were between age group of 51-60yr.…”

Section: Discussionmentioning

confidence: 99%

Optic Disc Edema/Papilledema: A Clinical Profile

Solanki¹,

Meena²,

Sharma³

et al. 2016

jemds

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AIMTo evaluate the clinical profile of patients with disc edema/papilloedema and its pattern in various patients. PURPOSETo evaluate causes of Disc edema/Papilloedema and associated clinical picture. DESIGNProspective Study. METHODThis study is a non-randomized prospective case series being conducted in the patients with disc edema attending OPD and referred from other departments to RIO, Gandhi Medical College and associated Hamidia Hospital, Bhopal from Jan 2013-Sept 2014. Detailed history was taken with special preference to diminution of vision, headache, nausea, vomiting, sensory motor deficits experienced by patient. Examination including visual acuity, pupillary reaction and ophthalmoscopy findings were noted. Findings of neuroimaging investigations as advised by medicine and surgery experts in cases suspected of raised intracranial tension were noted. RESULTSMost commonly affected age group was 11-20 years. Females: Males ratio were 4.1:3 with bilateral predominance. Intracranial Space Occupying Lesion (ICSOL) was most common cause of papilledema in bilateral (b/l) cases. Optic neuropathy was most common local cause of unilateral disc edema. Headache was the most common presenting complaint. On radiological investigations, most common finding was ICSOL followed by sinusitis followed by venous thrombosis, demyelination and infarction, Lateral Rectus (LR) palsy and diplopia each were found to be present in 4% cases of disc edema. CONCLUSIONIntracranial space occupying lesions as suggested by neuroimaging were the most common cause of papilledema. Other associations included hypertension, meningitis, pseudotumor cerebri, anaemia.The study emphasizes ophthalmoscopy in the diagnosis of papilledema and its importance in intervention of neurosurgeon in saving life and sight of person.

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“…Two proposed mechanisms are, first, anatomical nerve sheath anomalies preventing the transmission of the raised CSF pressure to the immediate retrobulbar region of the optic nerve, and, second, unilateral axoplasmic blockage of the lamina cribrosa 2. The absence of hydrocephalus in our patient with a blocked ventriculoperitoneal shunt may reflect an early stage of increased intracranial pressure or less pliable brain parenchyma in a young patient with past effects of aqueduct stenosis.…”

mentioning

confidence: 76%

“…Unilateral papilloedema is rare, being found in 2% of patients with papilloedema1 and occasionally occurs in idiopathic intracranial hypertension 2. Thus, unilateral papilloedema can pose a diagnostic challenge for the unwary clinician.…”

mentioning

confidence: 99%