Download - 10 Questions in Papilloedema
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Important questionsin papilloedema ?
Prof. K. Vengala Rao
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What causes OD to swell ?
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1. Pre laminar axon distension2. Extra cellular oedema
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Why pre laminar axons swell ?
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Blocked axoplasmic flow atlaminar gate
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What causes block inaxoplasmic flow ?
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1.Compression of axons
2.Ciliary ischemia
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Why is the ON so vulnerable
to raised ICP ?
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Ciliary flow to laminar region isweak (Choroidal steal)
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Can you distinguish
Ophthalmoscopically
papilloedema from other causes of
disc oedema ?
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Yes and NoPapilloedema is not segmental
Papilloedema is not pallid
Papilloedema is not monoocular (usually)
It can be asymmetricalDisc is more swollen than NFL
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What gets confused withpapilloedema ?
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Congenital OD elevation
Acquired causes that look like papilloedema
IONIncreased BP
Increased blood sugar (Papillopathy)
Indentation (Orbital mass)Inherited (LHON)
Intoxication (Methanol)
Infiltration (Cancer)Inflammation (Peri neuritis, Sarcoid, Posterior
Uveitis)
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Why does papilloedema look
like other causes of acquired
oedema ?
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Axoplasmic stasis is common to all
causes of disc oedema
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How to distinguish fromother causes ?
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Visual function is well preserved
Except in acute papilloedemaMacular oedema
Atrophic papilloedema
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Why is vision relativelypreserved in acute
papilloedema ?
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Elevated ICP impairs
axoplasmic flow less than local
causes
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Why does vision fall in
chronic papilloedema ?
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Shut down of all axoplasmic flow
(slow and fast)
Compression of ciliary vessels with
infarction
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Can you predict whether vision
will fail in papilloedema ?
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Not very well
Risk factors for vision failureSystemic Hypertension
High ICPPreexisting optic neuropathy
Disc pallor
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Can acute elevated ICP exist
with out papilloedema ?
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YES.!
Hayreh30% have papilloedema after 24
hrs90% have papilloedema after 5
days
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Does papilloedema reflect
current ICP elevation ?
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Not necessarilyIt takes papilloedema a longtime to go away after ICP
has normalized
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Can chronic elevated ICP
exist with out
papilloedema ?
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Not very often.!
Chronically elevated ICP canproduce unilateral (or very
asymmetrical) papilloedemaChronic elevated ICP can exist
with normal ODs (patients with
headache)
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Why might papilloedema not
occur in chronic ICP elevation ?
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Pressure rise is slow
No communication betweenintracranial and intra orbital
subarachnoid space
Atrophic ON
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What is the significance of
finding papilloedema ?
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ICP is (or was) elevated
If you do not find papilloedema,ICP has not been chronically
elevated
Ventriculomegaly does not mean
raised ICP
Small ventricle do not mean ICP isnormal
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What is the best surgical
treatment for papilloedema ?
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ONSF if there is fall of vision
LP shunt or VP shunt if headacheis severe
There is no comparative study sofar
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Thank
You