Papilloedema What Causes Investigations Risks IIHBIH Proposal Papilloedema

Papilloedema What Causes Investigations Risks IIH/BIH Proposal

Papilloedema • Swelling of the optic nerve head • • Characteristic appearances Common causes – Differentiating – Papillitis/Retrobulbar neuritis Common associations • Medical emergency

Papilloedema: • Causes: • • • Intracranial structural lesions Parenchymal mass lesions Intracranial vascular lesions Intracranial inflammatory lesions Intracranial infective processes CSF hyperproteiorrhachia

Papilloedema: Mass lesions: • Primary • Secondary • CSF – secondary hydrocephalus

Papilloedema

Papilloedema

Papilloedema:

Papilloedema: • Cortical venous sinus thrombosis

Papilloedema: • Thrombo-occlusive diseases: • Arterial and venous • Sickle cell disease • Behcets disease • Bacterial Endocarditis

Papilloedema: CNS infiltration: Lymphoma/TB Wegener’s/vasculitis Sarcoidosis Pituitary apoplexy Sinusitis Bacterial endocarditis

Papilloedema: • CNS infections • • Tuberculosis Toxoplasmosos Cryptococcus Syphilis • Acute bacterial meningitis • Trypanosomiasis • HIV

Papilloedema: • Investigations: • Parenchymal Imaging • Vascular imaging • CSF

Papilloedema: • What if? • • • Headaches Personality change Cranial nerve lesions Seizures Focal deficit – gait disturbance • And – visual failure

Papilloedema: • RICP • • Fluctuating headaches Vomiting False localising signs Pupillary fluctuation 6 th nerve Third nerve Cerebellar ataxia

Increased intracranial pressure

CSF: Lumbar puncture • • • CSF protein Glucose Cytology • GBS • Sarcoidosis SLE Scleroderma • Primary CNS lymphoma ALL

Papilloedema: • IIH/BIH • • • Headache diplopia tinnitus Papilloedema Obesity Girls CSF OP > 250 mm CSF

Idiopathic intracranial hypertension • • CSF dynamics Choroid production Arachnoid resorption Venous pressure (COPD/OSA/Pregnancy) Obesity/Cortisol/adipose 11 hydroxy steroid hydrogenase ? Influences CSF production/absorption Analogous to aqueous secretion

IIH/BIH • Warning – • Field losses severe • Acuity loss last to deteriorate • Treatments: Exclude causes: • • • CSF diversion LP etc Weight loss Diuretics? ?

Papilloedema: proposal • • Manage as a medical emergency Same day imaging CSF within 24 hours Visual field documentation/monitoring • Improve communication.