3. 3 COVID19 IN CHILDREN
1
2
3
Grading of Papilledema
(Frisen Grading Scale)
4
5
4. 32 y/o Woman
• C/o progressive headaches am
> pm
• BMI: 41
• BCVA: 20/20 OU
5. 0
1
0
2
OCT Analysis of
Papilledema
Increased NFL/MRW thickness
Elevation of nerve head (>0.8 mm from RPE
to apex)
0
3
0
4
Maintenance of central cup (until late disease)
Inward deflection of RPE/BM (N>T)
Subretinal hyporeflective space between
photoreceptor layer and RPE
(recumbent “lazy V”)
0
5
0
6 Peripapillary inner retinal folds (T>N)
8. 32 y/o Woman
• c/o progressive, debilitating
headaches x 2 mos.
• Normal neurologic exam
• BCVA: 20/20 OU
• BMI: 38
9.
10.
11. F/U x 6 mos
• Rx acetazolamide (500 mg BID)
• Weight loss (approx. 25 lbs.)
• Improvement in headaches
F/U x 14 mos
• D/C Diamox x 3 months
• More weight loss
• Headache free
Baseline
13. Pseudopapilledema
• An anomalous elevation of one or both
optic nerve without optic disc swelling
with a small or absent optic cup
Optic Disc Drusen
• Colloid bodies within substance of optic
nerve head
Due to Degeneration of NFL axons
• NFL may be thickened (< 7 clock hours) or
thinned
14. 0
1
0
2
OCT Analysis of
ODD
Always located above lamina cribrosa
Always have hyporeflective core with hyper-
reflective margin (most prominent superiorly)
0
3
0
4
PHOMS represent bulging axons
(should not be considered as ODD)
Hyper-reflective horizontal lines
(precursor to ODD or artifact)
Normal blood vessels
(superficial, hyperreflective core, shadow)
0
5
15. 33 y/o Woman
• Normal neurologic exam
• Consult for evaluation of
ODE OS
• BVA: 20/20 OU
16. 29 y/o woman
• BCVA: 20/20 OU
• History of migraine headaches
• No synchronous pulsatile tinnitus, diplopia or
transient vision loss
• Normal neurologic exam
• Consult for evaluation of papilledema
C-shaped halo of optic disc edema with sparing of the temporal papillomacular bundle Circumferential halo of optic disc edema
obscuration of major vessels as they leave the disc obscuration of major vessels on the surface of the disc
obscuration of all vessels on the surface of the disc
Minimum rim width
Hyperreflectivity of complex is pushed by subretinal fluid so Angle ( ) normal curvature of rpe bm below & inward deflection above
Hyporeflective temporal and nasal Wrinkles of inner retinal layers temporal d2 more fluids in subretinal space
G5
. Complete filling of cup
Rt G3 lt g3 encroach g4 relatively pink suggesting very well perfused
Flatting of sclera, kinking of optic nerve d2 dilatatin of subretinal spaces
Lt t1 empty sella sign (flatting of pituitary gland against floor of sella) with icp rt t2
6 signs
Normal flatting of optic nerve
Narrow canal crowdening of nerve fibers
الأسهم drusen
سهم من تحت Peripapillary hyper-reflective ovoid mass-like structures evident 360 degrees-corresponding “blurred” disc margins Associated with CRVO, myopic disc tilt, optic neuritis
Elevated disc, no central cup
السهم برتقالي odd nasal, temporal السهم ازرقhorizontal سهم بنفسجي blood vessel
Elevated disc no cup blood vessels not obscured … no clinical evidence of disc oedema
Ovoid area ODD
Contralateral “bow tie” optic atrophy and RAPD
Contralateral homonymous hemianopia
Contralat rt ipsilat lt homonemous thinning
Glaucomatous patient with thinning GCL.. Rt homonemous GCL thinning .. Contralateral retroch lesion
Mri: very large cyst in lt side Vf: arcuate scotoma of glaucoma … rt HH
Rt normal lt Optic neuritis July slightly theckining
semptember fibraury progressive thinning
Rt temporal wedge of pallor lt normal
Rt thinning is accepted but why in lt eye without neuritis
Mri multiple lesions of MS
BI temporal thinning even with no ON