Terms in this set (45)
Presentation of Papilledema with what is a medical emergency?
What does having papilledema signify?
Serious neurologic problem
Papilledema most commonly occurs bilaterally or unilaterally?
Definition of Papilledema
Swelling of optic disk from elevated intracranial pressure
Papilledema can be a sign of?
Underlying brain mass
Brain masses have risks for?
Conditions that can have papilledema
space occupying lesions
Dural sinus thrombosis
Pseudotumor cerebri (idiopathic intracranial hypertension)
disk edema from ICP; commonly bilateral
>200mm of water in non obese patient
>250mm of H20 in obese patients
Downward brain tissue displacement
Abnormal excessive CSF in brain accumulation
Test for evaluating CSF
Fluid collected at L4-L5
What would be helpful to characterize the mass lesion?
What else will CT show?
Impending cerebral herniation
What can an MRI be useful for?
Excluding dural sinus venous thrombosis
For patients with pseudotumor cerebri, what will neuroimaging show?
Neuroimaging appears normal typically, but can show:
-enlarged optic nerve sheaths
-small slit-like ventricles
If nueroimaging does not show mass lesion, what study can be done?
What position does not allow for accurate opening pressure?
High volume tap
When high amount of CSF is removed due to high opening pressure
What is the CSF analyzed for?
Cell count with differential
-Color and fluid clarity
What does CSF help evaluate for?
What does CSF show for pseudotumor cerebri?
What does papilledema result from?
Axoplasmic flow stasis in the slow axoplasmic transport system
Where is the pressure from ICP transmitted?
to the subarachnoid
What does the subarachnoid encompass?
Entire optic nerve
What is the subarachnoid continuous with?
Optic nerve sheath
How does ICP affect the optic nerve?
ICP block axoplasmic transport resulting in edema of the nerve and optic disc
The term papilledema is specifically associated with?
Disk edema caused by increased intracranial pressure
-transient visual obscuration or graying out/dimming of vision
-->occurs after bending over
-sudden visual loss: from intraocular hemorrhage resulting from neovascularization from chronic papilledema
-blurring and distortion of central vision
-progressive loss of peripheral vision
What vision issues can occur later with papilledema?
Loss of color perception
Loss of central visual fields
Idiopathic intracranial HTN or benign intracranial HTN
Typical Pseudotumor cerebri patient
-Young obese women
-1 in 100,000 incidence; slightly higher in obese women
Pseudotumor cerebri is a diagnosis of ____
What findings are required to diagnose pseudotumor cerebri?
Nonfocal neurologic signs (except 6th nerve palsy)
Normal imaging studies
Normal CSF studies (except for elevated opening pressure)
Most common age of pseudotumor cerebri presentation?
Pseudotumor cerebri pathophysiology?
-Resistance to CSF absorption across arachnoid villi
-abnormal cerebral venous outflow
Typical signs of pseudomotor cerebri?
transient visual obscuration
horizontal diplopia from 6th nerve palsy
Headache that occurs with PC?
Worse in mornings
Worse with valsalva maneuver
Most common abnormality in clinical exam in pseudomotor cerebri?
Bilateral disk edema
What are the risk factors for pseudomotor cerebri?
Obesity, Recent weight gain
Female gender-reproductive age, Menstrual irreg
What other diseases can pseudotumor cerebri be associated with?
chronic renal failure
systemic lupus erythematosus
What medication is pseudotumor cerebri associated with?
Treatment of pseudotumor cerebri
High volume lumbar puncture at initial evaluation
Long term treatment (medical)
If medical treatment doesn't work
Lumbar peritoneal shunt or ventriculoperitoneal shunt
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