1. PAPILLOEDEMA

2. Papilloedema
 It is swelling of optic nerve head due to
raised ICP .
 It is nearly always bilateral.
 All patient with papilloedema should be
suspected of having intracranial mass.

3. Production of CSF
CSF is formed by Choroid plexus in
the ventricles of the brain .
Normal CSF pressure 10-18 cm H2O

4. Circulation of CSF Fluid
Lateral ventricle Lateral ventricle
Foramina
of Munro
Third ventricle
Fourth ventricle
Sylvian
aqueduct
Sub arachnoid
space
Foramina of
Luschka and
Megendie
Cerebral venous
system
Absorption
Via Arachnoid
villi

5. Circulation of CSF Fluid

6. Causes of raised ICP
 Idiopathic intracranial HTN.
 Obstruction of ventricular system.
 Space occupying intracranial lesions.
 Impairment of CSF absorption.

7. Cerebral venous sinus thrombosis .
 Cerebral oedema from blunt head
trauma .
Severe systemic HTN.
Hypersecretion of CSF
Causes of raised ICP

8. Causes of raised ICP

9. Causes of optic disc elevation
1.Papilloedema
2. Accelerated hypertension
3. Anterior optic neuropathy
- Ischaemia
- Inflammatory
- Infiltrative
- Compressive

10. 4. Pseudopapilloedema
- Optic disc drusen
- Tilted optic disc
- Peripapillary myelinated nerve fibres
- Crowded disc in hypermetropia
5. Mitochondrial optic neuropathy
- Leber hereditary optic neuropathy
- Methanol poisoning

11. 6. Intra ocular disease
- Central retinal vein occlusion
- uveitis
- Posterior scleritis
- Hypotony

12. Clinical features of raised ICP
 Headache
 Nausea
 Deterioration of consciousness .
 Visual symptoms :
- Transient obscurations
-Horizontal diplopia
-Vision reduction

13. Fig.Mechanism of sixth nerve palsy due to raised
intracranial pressure
Dilated ventricles
Petrous tip
Brainstem pushed downwards

14. Stages of papilloedema
• Optic disc show mild hyperaemia
with preservation of the optic cup.
• Indistinct peripapillary retinal
nerve striations and disc margins.
Early stage

15. Papilloedema. ( Early)

16. • VA is normal or reduced .
• Optic disc shows severe hyperaemia ,
moderate elevation with indistinct margin
and absence of the physiological cup.
• Venous engorgement , peripapillary flame
shaped hemorrhage ,frequently cotton
wool spots .
• Macular fan
• Blind spot is enlarged.
Established

17. Papilloedema.- acute established

18. • VA is variable and visual fields begin to
constrict
• Optic disc is not elevated
• Cotton wool spots and hemorrhages are absent
• Opto-cilliary shunt and drusen like crystalline
deposits may be present on the disc surface .
Chronic

19. Papilloedema.-chronic

20. • VA is severely impaired .
• The optic discs are grey-white , slightly
elevated with few crossing blood vessels
and indistinct margin.
Atrophic (Secondary optic atrophy)

21. Papilloedema- atrophic

22. Investigations
 B-scan ultrasonography
 CT scan of brain
 MRI of Brain
 Venography
 Lumbar puncture

23. Treatment
 According to cause .
 Neuro-surgical consultation .
 Method of reducing ICP
Mannitol infusion
CSF withdrawal
Sedative –propofol, barbiturate
Control hyperventilation
Decompressive craniotomy
Removal of mass lesion if present
Hypothermia
Steriods

24. Treatment
 Shunt technique
Ventriculoperitoneal shunt
Lumboperitoneal shunt
Ventriculoarterial shunt

25. Complication
 Visual loss.
 Chronic headche.
 Complication related to lumbar puncture.
 Complication related to shunt.

26. Thanks to all