Introduction about Disc Edema with a few case scenarios to understand the differentials

1. EVALUATION OF A PATIENT
WITH DISC EDEMA
Presented By:
Dr. Rakshan Reyaz

2. CONTENTS
• History
• Introduction
• Optic Disc Edema
• Papilloedema
• Pseudopapilloedema
• Case Histories

3. HISTORY
• In 1860, Albrecht Von Graefe reported ONH swelling in patients with brain tumour
and called it “Stauungspapille”
• In 1908, Parsons coined the term Papilloedema.
• In 1911, Paton and Holmes differentiated between Papilloedema with raised ICP and
Optic Neuritis.

4. INTRODUCTION
OPTIC DISC EDEMA: True disc selling due to any cause
PAPILLOEDEMA: True disc swelling secondary to raised intracranial
pressure
PSEUDOPAPILLOEDEMA: A swollen disc not due to a axonal
swelling

5. OPTIC DISC EDEMA
• A non specific term describing localized
swelling anterior to the lamina cribosa.
• MECHANICAL SIGNS:
i. Elevation of the Optic Disc
ii. Blurring of the optic disc margins
iii. Filling of the optic cup
iv. Edema of the peripapillary nerve fiber
v. Retinal or Choroidal folds (Paton
Lines)

7. • VASCULAR SIGNS:
i. Hyperemia of the disc
ii. Venous Congestion
iii. Peripapillary Hemorrhages
iv. Exudates
v. Nerve Fiber Layer infarcts
vi. Absence of SVP

9. PAPILLOEDEMA
• Passive edema of the disc without any
inflammation due to raised ICP.
• Usually Bilateral
• Transient attacks to blurring of vision.
Vision later decreases due to disc
atrophy
• Symptoms of raised intracranial
pressure
• FFA: Leakage

10. MECHANISM

11. FRISEN GRADING

12. PSEUDOPAPILLOEDEMA
• Unilateral
• Defective vision depending on the degree
of refractive error
• Hemorrhages, Exudates, Peripapillary
edema, Venous engorgement : Absent
CAUSES:
a) Optic Disc Drusen
b) Tilted Optic Disc
c) Myelinated Nerve Fibers
d) Crowded hypermetropic disc
e) Optic nerve hypoplasia

14. CASE HISTORIES

15. CASE-1
• 35yr, Female
• C/O severe headache x 4 months,
vomiting
• Vision 6/6, AS: WNL
• Fundus: Bilateral Disc Edema
• MRI

17. CASE-2
• Middle aged female
• Obese
• h/o OCP use
• c/o chronic headache, blurring of vision
• AS:WNL
• Fundus: b/l disc edema
• MRI: Normal
• Neurological exam: Normal
• CSF Analysis: Normal Composition

19. CASE-3
• 26yr, male
• c/o headache, neck stiffness, vomiting,
blurred vision, seizures
• AS: conjunctival congestion
• Fundus: Disc Edema, Vessel tortuosity,
hemorrhages
• Contrast CT- Normal
• MRI/ MR Venogram: clot and lack of
flow

21. CASE-4
• 35yr, male
• c/o episodic blurring of vision
• Vision: 6/6 , AS: WNL
• Colour Vision: Normal
• VF: Enlargement of the Optic Nerve
Head
• Fundus: Blurred disc Margins, lumpy
calcific bodies in the ONH
• B- Scan: hyperechoeic lesion in the
ONH, shadowing

23. CASE-5
• 30yr, Female
• Uncontrolled sugars
• c/o diminution of vision in both eyes,
vision: 6/12 , AS:WNL
• Colour Vision: Normal
• Fundus: mild disc edema + Moderate
NPDR
• Neuroimaging: Normal

24. CASE-6
• 60yr, Male, Smoker
• K/C/O HTN (on erratic treatment)
• C/O diminiution of vision, headache
• Vision: 6/60, Sluggish Pupils
• Blood Pressure: 190/100mmHg
• Fundus: Disc Edema, Macular Star,
Cotton wool spots, Hemorrhages

25. CASE-7
• 30yrs, Female
• C/O decreased vision x 1week
• Burning sensation of lower limbs, straining
micturition, back pain
• Vision: PL+, Dilated Sluggish pupils
• Fundus: Disc Edema, Pallor
• Impaired Colour Vision
• Neurological Exam: Paraparesis, Extensor
plantar response
• MRI: features of grey and white matter
demyelination, plaques, thickened ON
Sheath
• Spine : Hyperintense lesions

28. CASE-8
• 30yrs, Female
• C/O Headache, Unilateral Diminution of
Vision x 1day
• Vision: 6/36, RAPD
• Painful ocular movements, defective
colour vision
• Fundus: disc edema, peripapillary flame
shaped hemorrhages

29. CASE-9
• 58yrs, Male
• K/C/O Dyslipidemia, HTN
• Painless profound loss of vision
discovered in the morning
• Vision: 4/60, RAPD, Impaired Colour
Vision
• Fundus: Disc Edema, Altitudinal Pallor
• VF: Inferior Altitudinal Field Defect

31. CASE-10
• 75yr, Female
• C/O sudden unilateral painful loss of
vision, Vision: 2/60
• Headche, pain while combing and
chewing
• Fever, weight loss, malaise
• Fundus: Pallid Disc Swelling, Cotton
wool spots, splincter hemorrhages,
chalky pallor
• ESR: raised

33. CASE-11
• 34yr, Male
• C/O DOV in LE following Blunt Trauma
• Vision: 5/60 in LE
• IOP: 7mmHg in LE
• Fundus: Disc Edema, chorioretinal folds,
macular edema

34. CASE-12
• 65yr, Male
• C/O Bilateral gradually progressive loss
of vision
• H/O febrile episodes, weight loss, neck
swellings
• Fundus: disc edema, granulomas