Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Findings ++ Papilledema (optic nerve edema) is associated with increased intracranial pressure due to any cause, such as tumor, craniosynostosis, or intracranial infection Occurs almost equally in boys and girls and sometimes is associated with obesity or upper respiratory tract infection Other associated causes are viral and other infections, corticosteroid use or withdrawal, sinus infection, trauma, tetracycline use, growth hormone supplementation, and venous sinus thrombosis +++ Clinical Findings ++ Hydrocephalus and intracranial tumors are common causes of papilledema In idiopathic intracranial hypertension (pseudotumor cerebri), neuroimaging is normal but papilledema, headaches, and pulsating tinnitus may be present Early in the illness the patient may not notice a change in vision, although the blind spot may be enlarged Transient obscuration of vision (amaurosis fugax) may occur as the process becomes more long-standing Further effects on vision occur as the papilledema becomes chronic and ultimately leads to optic atrophy Diplopia (double vision) may occur if increased intracranial pressure results in cranial nerve VI palsy Workup and treatment are directed toward finding the underlying systemic or central nervous system cause +++ Diagnosis ++ Direct visualization of the optic nerve by ophthalmoscopy reveals an elevated disc with indistinct margins, increased vessel diameter, vessel tortuosity, and hyperemia Hemorrhages and exudates are present in more severe cases Observed changes may be subtle to striking Optic nerve head changes are usually bilateral and generally symmetric +++ Treatment ++ Idiopathic intracranial hypertension may be treated using acetazolamide or a corticosteroid Discontinue medications that are suspected of causing papilledema Administer anticoagulation if venous sinus thrombosis is present Diagnostic lumbar puncture may also be curative Optic nerve sheath fenestration and ventriculoperitoneal shunt are surgical interventions used when conservative measures fail Strabismus surgery, Botox (botulinum toxin type A) injection of extraocular muscles, and amblyopia treatment may be necessary in cases of associated cranial neuropathies resulting in strabismus Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.