II. Signs

  1. Early and mild Papilledema
    1. Subtle gray peripapillary halo
      1. Normal radial Optic Nerve Head disrupted
      2. Nerve fibers accentuated by grayish opacity
    2. Concentric folds of the retinochoroid
  2. Moderate Papilledema
    1. Borders of Optic Disc become obscure
    2. Disc margins are progressively elevated
    3. Nerve head diameter increases
    4. Major blood vessels leaving the disc are obscured
  3. Severe Papilledema
    1. Optic Nerve Head protrudes
    2. Peripapillary halo demarcated
    3. Optic Cup is obliterated

III. Signs: Associated findings

  1. Loss of spontaneous Retinal vein pulsations
    1. Pulsations disappear at CSF Pressure > 250 mm water
    2. Unreliable sign
      1. Many normal patients lack venous pulsations
  2. Hyperemia
  3. Retinal vessel tortuosity
  4. Retinal Hemorrhages
  5. Retinal exudates
  6. Nerve fiber infarctions (cotton wool spots)
  7. Optic Nerve pallor

IV. Interpretation

V. Causes: Pseudopapilledema

  1. Optic Disc drusen
  2. Tilted Optic Disc

VI. Diagnostics

  1. Stereoscopic indirect Fundoscopy
  2. Optic Nerve Ultrasound
    1. Drusen are highly reflective
    2. Papilledema shows a distended Optic Nerve sheath

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Papilledema (C0030353)

Definition (MSHCZE) Stav, kdy papila zrakového nervu (discus nervi optici) prominuje dovnitř bulbu. Diagnostický znak nitrolební hypertenze. Papila má neostrou hranici, je edematózní, mohou být patrny známky krvácení. Míru prominence lze vyjádřit v dioptriích. Zrak nemusí být zpočátku narušen. Oftalmoskopické vyšetření je indikováno při bolestech hlavy, mozkové příhodě, susp. tumorech mozku aj. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_NCI-GLOSS) Swelling around the optic disk, the area where the optic nerve (the nerve that carries messages from the eye to the brain) enters the eyeball. Papilledema occurs when increased brain pressure caused by tumors or other problems results in swelling of the optic nerve.
Definition (NCI) Swelling around the optic disc, usually due to increased intracranial pressure or pressure on the optic nerve by a tumor.
Definition (NCI_CTCAE) A disorder characterized by swelling around the optic disc.
Definition (MSH) Swelling of the OPTIC DISK, usually in association with increased intracranial pressure, characterized by hyperemia, blurring of the disk margins, microhemorrhages, blind spot enlargement, and engorgement of retinal veins. Chronic papilledema may cause OPTIC ATROPHY and visual loss. (Miller et al., Clinical Neuro-Ophthalmology, 4th ed, p175)
Definition (CSP) swelling of the optic disk, usually in association with increased intracranial pressure, characterized by hyperemia, blurring of the disk margins, microhemorrhages, blind spot enlargement, and engorgement of retinal veins.
Concepts Disease or Syndrome (T047)
MSH D010211
ICD9 377.00, 377.31, 377.0
ICD10 H47.1 , H46.0, H47.10
SnomedCT 423341008, 423488006, 248487006, 111526001, 194038006, 194041002, 155187009, 73221001
English Choked Disk, Choked Disks, Disk, Choked, Disks, Choked, Papillitis optic, OPTIC PAPILLITIS, OPTIC DISCS BLURRED, PAPILLEDEMA, PAPILLOEDEMA, Papilledema, unspecified, Papilloedema NOS, Unspecified papilloedema, Edema, Optic Disk, Edema, Optic Papilla, Edemas, Optic Disk, Edemas, Optic Papilla, Optic Disk Edema, Optic Disk Edemas, Optic Papilla Edema, Optic Papilla Edemas, Papilloedema, unspecified, Optic disc oedema, Optic disc edema (disorder), Optic disc edema, Papilledema, Optic disc swollen, optic papillitis (diagnosis), papilledema, papilledema (physical finding), papilledema (diagnosis), optic papillitis, Optic discs blurred, Disc congestion in ocular fundus, Disc edema in ocular fundus, Optic disc engorgement, Disc oedema in ocular fundus, Optic disc inflammation, Papillitis NOS, Papilledemas, Papilloedema, Papilledema NOS, Unspecified papilledema, Papilledema [Disease/Finding], optic disc edema, disc inflammation optic, choked discs, disk choked, papillitis, optic disc swelling, swollen optic disc, Papillitides, Optic Nerve Papillitides, Nerve Papillitides, Optic, Nerve Papillitis, Optic, Papillitides, Optic Nerve, Papillitis, Papillitis, Optic Nerve, Optic Nerve Papillitis, Papillitis, Optic, Optic Papillitis, Papilledema (disorder), Choked disc, Unspecified papilledema (disorder), Choked disk, Papilledema NOS (disorder), Blurring of optic disk, Papilloedema (disorder), Optic papillitis, Optic disc swelling, Optic disc swelling (finding), Optic papillitis (disorder), choked disk, optic; papillitis, papillitis; optic, Papilledema, NOS, Blurring of optic disc, papilloedema
French OEDEME PAPILLAIRE, Oedème papillaire, non précisé, Oedème papillaire dans le fond d'oeil, Engorgement de la papille optique, Papillite SAI, Inflammation de la papille optique, Papillite optique, Congestion papillaire dans le fond d'oeil, Oedème discal découvert en fond de l'oeil, FLOU PAPILLAIRE, INFLAMMATION PAPILLE OPTIQUE, Flou papillaire, Papillite, Oedème papillaire
Spanish PAPILEDEMA, Papilitis NEOM, Papilitis óptica, Congestión del disco óptico, Inflamación del disco óptico, Edema de disco en fondo ocular, Congestión del disco en el fondo de ojo, Edema del disco en el fondo de ojo, Papiloedema, no especificado, Papiledema no especificado, edema de papila óptica (trastorno), edema de papila óptica, PAPILA BORROSA, PAPILITIS OPTICA, tumefacción de papila óptica (hallazgo), tumefacción de papila óptica, edema de la papila óptica, tumefacción de la papila óptica, tumefacción de la papila óptica (hallazgo), Papilitis Óptica, borramiento de papila óptica, papiledema no especificado (trastorno), desdibujamiento del disco óptico, disco estrangulado, edema del disco óptico, papiledema no especificado, papiledema (trastorno), papiledema, SAI (trastorno), papiledema, papiledema, SAI, edema de papila, papilitis óptica (trastorno), papilitis óptica, Papilas borrosas, Papilitis, Papiledema, Edema de la Papila Óptica, Edema de la Papila, Edema del Disco Óptico
German PAPILLENOEDEM, Entzuendung der Papille, Optikuspapillitis, Papillenschwellung, Papillenoedem, unspezifisch, Papillitis NNB, Papillenoedem am Augenhintergrund, Papillenstauung am Augenhintergrund, OPTIKUSPAPILLITIS, PAPILLE UNSCHARF, Stauungspapille, nicht naeher bezeichnet, Papillenoedem, Papille unscharf, Papillitis, Stauungspapille, Optikuspapillenödem, Papilla-optica-Ödem, Papillenödem
Portuguese EDEMA PAPILAR, Edema da papila, Edema da papila NE, Edema papilar do fundo do olho, Inflamação da papila óptica, Congestão papilar do fundo do olho, Papilite NE, Papilite óptica, Congestão da papila óptica, OPACIFICACAO PAPILAR, PAPILITE OPTICA, Papilite Óptica, Edema papilar, Papilas ópticas esfumadas, Papilite, Edema da Papila Óptica, Edema do Disco Óptico, Edema Papilar, Papiledema
Italian Dischi ottici pallidi, Papillite, Edema del disco ottico all'esame del fondo oculare, Papillite NAS, Congestione del disco ottico all'esame del fondo oculare, Papilledema non specificato, Infiammazione del disco ottico, Papillite ottica, Edema del disco ottico, Gonfiore del disco ottico, Papilledema
Dutch niet-gespecificeerd discusoedeem, discusoedeem in fundus oculi, discus congestie in de fundus oculi, discusitis opticus, papilloedeem, niet-gespecificeerd, opticus discus congestie, opticus discus ontsteking, opticus discusitis, papillitis NAO, optica; papillitis, papillitis; optica, Papiloedeem, niet gespecificeerd, discusoedeem, onduidelijke opticus discus, papillitis, Oedeem van de discus nervi optici, Oedeem, papil-, Opticuspapiloedeem, Papiloedeem
Japanese 乳頭炎NOS, 視神経乳頭浮腫、詳細不明, 乳頭炎, 視神経乳頭の炎症, 視神経乳頭炎, 視神経乳頭辺縁不鮮明, シシンケイニュウトウフシュショウサイフメイ, ニュウトウエン, シシンケイニュウトウエン, シシンケイニュウトウフシュ, シシンケイニュウトウノエンショウ, ニュウトウエンNOS, シシンケイニュウトウヘンエンフセンメイ, 視神経乳頭浮腫, 乳頭水腫, 鬱血乳頭, シシンケイニュウトウウッケツ, 視神経乳頭うっ血, 乳頭浮腫, うっ血乳頭
Swedish Papillödem
Finnish Näköhermon nystyn turvotus
Russian ZRITEL'NOGO NERVA DISKA OTEK, ЗРИТЕЛЬНОГО НЕРВА ДИСКА ОТЕК
Czech Optická papilitida, Edém paplily, blíže neurčený, Edém papily, Edém papily, blíže neurčený, Papilitida, Městnání terče zrakového nervu, Zánět papily zrakového nervu, Edém terče očního fundu, Zánět terče zrakového nervu, Papilitida NOS, Edém terče na očním fundu, Zkalený optický disk, Kongesce zrakového terče na očním fundu, městnavá papila, papiledém, edém oční papily, edém papily zrakového nervu, zduřelá papila, papilitida
Korean 상세불명의 유두부종
Polish Obrzęk tarczy nerwu wzrokowego
Hungarian Papilla oedema a szemfenéken, Elmosott szélű papilla, Papillitis, Papillaoedema, Papillitis nervi optici, Papillaoedema, nem meghatározott, Papillaris pangás a szemfenéken, Papilla megnagyobbodás, Papilla optica gyulladása, Papillitis k.m.n., Látóidegfő gyulladás
Norwegian Synsnervepapillebetennelse, Papillitt, Stasepapill, Synsnervepapilleødem, Papilleødem