papilledema
Introduction
Introduction The papilledema is also called the nipple. It is a passive congestive edema with no primary inflammation of the optic nerve head. Under the ophthalmoscope, the nipple is congested, bulged and blurred. Optic papilledema is not a truly independent disease, but a common sign that causes a balance of pressure imbalances on both sides of the screen. Often caused by intracranial, intraocular, intraorbital, and certain systemic diseases.
Cause
Cause
Optic papilledema is caused by an increase in intracranial pressure. Optic papilledema is almost always bilateral, caused by brain tumor or brain abscess, brain trauma or bleeding, meningitis, arachnoid adhesions, cavernous sinus or dural embolism, encephalitis, space-occupying brain disease, severe hypertension and Caused by emphysema. Pseudo-brain tumors can also cause papilledema, but it is much lighter than other causes. Because papilledema is a sign of elevated intracranial pressure, further testing or intervention is needed to find the cause.
Examine
an examination
Related inspection
CT examination of CT in the eye and temporal area
In the early stage of edema, there is often a paroxysmal transient visual obscenity, but the visual acuity can be completely normal. After the embarrassment, as the disease progresses, the transient vision is more frequent, and even transient black spots occur. (This situation occurs when the patient stands up quickly and turns his head sharply. Therefore, the patient's action is slow. Cautiously, vision has gradually declined. Visual field examination showed an expansion of the physiological blind spot. If the edema of the nipple can not be relieved for a long time, the optic nerve fiber is progressively atrophied, the visual impairment is becoming more and more serious, and the visual field is enlarged except for the expansion of the physiological blind spot.
The majority of binocular optic nerve head edema is caused by an increase in intracranial pressure caused by intracranial space-occupying lesions or systemic diseases, as described above. Therefore, patients often have headaches, nausea, vomiting and other related symptoms and signs. Most of the monocular patients are due to lesions in the iliac crest, often accompanied by eyeballs.
Early fundus changes, nipple congestion, nasal and upper and lower lateral margins, and physiological depressions, etc., but these indications can only be used as a basis for suspicion due to individual differences and overlap between physiology and pathology, so it must be strengthened Follow-up. Repeated inspections within a few days to observe the development of the situation can be determined. Although the nipple has no bulge, such as nipple congestion, white streaks around the nipple, and retinal vein filling, pressurization in the eye can not see the central retinal venous pulsation (referred to as venous pulsation) disappeared, then the diagnosis can be established.
The edema is further developed, and the various fundus changes described above are becoming more and more obvious. The edema of the nipple edema gradually increases and expands to the periphery, making the boundary more blurred or even completely disappeared. The nipple height is generally over 3.0D out of the retina plane, and in severe cases it can exceed 7.0D. Retinal vein anger is distorted, and the ratio of arteriovenous diameter is from 1:2, 1:3, or even more than 1:4. Linear or flaming hemorrhage spots can be seen on the surface of the edema of the nipple and around it, varying in number and size. The degree of edema is not necessarily proportional to the height of the intracranial pressure, and it seems to be more closely related to the location of the intracranial lesion.
Diagnosis
Differential diagnosis
It is quite difficult to determine the early stage of papilledema. It must be observed repeatedly within a few days to judge the development. After the edema of the nipple is becoming more and more obvious, the diagnosis is not difficult, but it should be differentiated from optic papillitis.
Vision: The former is normal early and can be lowered in the late stage. The latter fell sharply.
Fundus: The former nipple congestion and edema, uplift more than 3D, peripheral retinal edema, bleeding retinal vein angulation, venous pulsation disappeared, late secondary atrophy. The latter nipple congestion and edema uplifted below 3D, peripheral retinal edema, bleeding, exudation, venous engorgement, and secondary secondary atrophy.
Vision: The former has a deeper physiological blind spot and a narrower centripetality. The dark center of the latter or the dark spot of the center.
Course of disease: The former nipple edema has a long time, up to 1-2 years. The latter nipple edema disappears quickly and usually resolves after 1 month.
Intracranial pressure: the former has increased. The latter is not high.
Eye side: The former is more common on both sides. The latter is often unilateral.
It is best to treat papilledema caused by increased intracranial pressure for the cause of increased intracranial pressure. Symptomatic treatment of dehydrating agents such as hypertonic solutions (such as mannitol, sorbitol, etc.) is also necessary. When the high intracranial pressure can not be resolved in a short period of time, in order to prevent the optic nerve atrophy caused by the long-term edema of the papillary edema, it can be used as an internal optic nerve hard sheath ostomy. In order to reduce the tissue pressure of the optic nerve behind the sieve plate, alleviate the edema of the optic papilla and protect the visual function.
