DDx:
• Hydrocephalus
• Intracranial mass
• Oedema
• Meningitis
• Venous obstruction
• Dural Fistula
• Increased CSF protein
• Increased CSF pressure
|
Grade |
Description |
|
0 Normal |
Normal disc |
|
1 Minimal |
C-shaped halo with temporal gap, grayish,
obscures underlying retinal details Disruption of normal radial nerve fibre later arrangement striations Temporal disc margin normal |
|
2 Low grade |
Circumferential halo Elevation (nasal border) No major vessel obscuration |
|
3 Moderate |
Obscuration of 1 or more segments of major blood vessels leaving the
disc Circumferential halo Elevation (al borders) Halo (irregular outer fringe with finger like-extensions) |
|
4 Marked |
Total obscuration on the disc of a segment of a major blood vessel on
the disc Elevation (whole nerve head, including the cup) Border obscuration (complete) Halo (complete) |
|
5 Severe |
Obscuration of all vessels on the disc and leaving the disc |
Diagnosis
• MRI brain with MRV
• LP
o Opening pressure
o Protein
o Cytology
Diagnostic issues
• Papilloedema is insensitive to acute rises in ICP – only ~20% of patients develop it acutely
• Papilloedema is probably present in 50-80% of cases of chronically raised ICP
• Unilateral papilloedema can be seen in raised ICP (?~5% of cases)
• Visual loss should only occur with raised ICP if papilloedema is present
There appears to be some, albeit poor, correlation of the degree of papilloedmea and degree of visual loss