Papilledema is generally defined as bilateral edema of the head of the optic nerve due to increased intracranial pressure. It is a common finding in malignant hypertension, pseudotumor cerebri, intracranial tumors, and hydrocephalus. Any disease process that increases the ICP and thereby inhibits vascular or axoplasmic flow in the optic nerve causes congestion and edema of the nerve head. When only one nerve head is involved, it generally is not related to increased ICP. Monocular optic nerve edema or binocular involvement not associated with increased ICP is usually referred to as optic nerve edema or, if inflammatory in origin, papillitis (i.e., optic neuritis). Frequently the term papilledema has been used interchangeably in the literature to refer to monocular or binocular nerve head edema; however, most neuro-ophthalmologists reserve the term papilledema for bilateral nerve involvement due to increased ICP. Regardless of the etiology, the clinical findings on ophthalmoscopy of papilledema and papillitis are identical: the disk margins are blurred, the cup is diminished or absent, and the nerve head is elevated with vascular congestion (Fig 2.3.0.-2.2., Elaie...20). Frequently flame-shaped hemorrhages are seen on or adjacent to the nerve head. A distinguishing feature of papilledema is prolonged preservation of visual acuity (frequently patients are visually asymptomatic). In this respect they differ markedly from patients with optic neuritis, who generally present with decreased visual acuity.

FIG. 230-22. (Plat.e,2.0). Optic nerve head edema. Vascular congestion, elevation of the nerve head, and blurred disk margins are characteristically seen in papilledema, papillitis, and compressive lesions of the optic nerve.

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