Papilledema

Optic disc swelling from raised brain pressure

Overview

Papilledema is swelling of the optic discs caused by raised pressure inside the skull. The term is reserved for disc swelling of this cause, and it is usually bilateral. Elevated intracranial pressure transmitted along the optic nerve sheath impairs axonal transport in the nerve, producing a swollen, elevated disc with blurred margins. Causes include brain tumors and other masses, cerebral venous sinus thrombosis, meningitis, hydrocephalus, and idiopathic intracranial hypertension, which occurs most often in young women with obesity. Associated symptoms of raised intracranial pressure include headache, nausea, brief episodes of dimming of vision called transient visual obscurations, pulsatile tinnitus, and double vision from sixth nerve palsy. Visual acuity often remains good early on, but prolonged papilledema can cause progressive visual field loss. Evaluation involves neuroimaging and often lumbar puncture, and treatment is directed at the cause. Pseudopapilledema, an elevated disc appearance from causes such as optic disc drusen, can mimic it.