Papilledema

Papilledema (abbreviation: Stapa, English name: papilledema ) refers to swelling ( edema) of the exit of the optic nerve ( optic nerve ) from the eyeball ( optic nerve head ).

A papilledema is usually in the form on both sides. A rare exception, the Foster Kennedy syndrome, occurs when the second cranial nerve is compressed by a space-occupying process in the anterior cranial fossa: This creates an ipsilateral optic atrophy and contralateral to the space ford forming process location (ie, one-sided ) papilledema.

Causes

This swelling occurs most often in conjunction with an increased pressure in the skull on the inside ( intracranial pressure ). This can for example be caused by a brain tumor, increased blood pressure, inflammation or infection of the brain or bleeding in the brain or the meninges ( epidural hematoma ) with subsequent displacement of the brain. If no cause for the increased intracranial pressure can be found, you may have a so-called pseudotumor cerebri before, increased intracranial pressure due to pent-up cerebrospinal fluid. The papilledema is an expression of chronified Intracranial pressure, it is found only in a long, slowly progressive intracranial pressure. However, it is not typical for an acute intracranial hypertension.

Other diagnostic

The papilledema may be accompanied by headaches and visual disturbances. Drug of choice for a finding of papilledema is the reflection of the fundus (ophthalmoscopy ). In some cases it may also be helpful ultrasonography of the eyeball. The finding of papilledema requires the immediate search for underlying causes inside the skull, and especially in the brain, which should be done by a computer tomography or magnetic resonance imaging with a neurological examination, including imaging of the skull inside. A lumbar puncture for removal of cerebrospinal fluid ( CSF ) in the presence of papilledema should be made only after exclusion of intracranial space-occupying lesion and then necessarily involve a liquor pressure to rule out pseudotumor cerebri. In the presence of a mass this should be avoided, however, as it could then be associated with the risk of a life-threatening herniation of the brain stem.