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  3. Picture quiz Disc swelling or papilloedema?
Student Education

Picture quiz Disc swelling or papilloedema?

BMJ 2007; 334 doi: https://doi.org/10.1136/sbmj.0706234 (Published 01 June 2007) Cite this as: BMJ 2007;334:0706234
  1. Marie-Noëlle Lazaridou, senior house officer in ophthalmology1,
  2. Syed Muhammad Asad Ali, fellow in ophthalmology1,
  3. Bal Manoj, consultant ophthalmologist1
  1. 1Wolverhampton and Midland Counties Eye Infirmary, Wolverhampton WV3 9QR

A 10 year old girl presented with a two week history of back pain and a one day history of vomiting and headache. She did not have any significant deterioration of visual acuity, but colour vision was impaired, as were the visual fields. Fundus photographs of both eyes are shown below (figs 1 and 2). Computed tomography and magnetic resonance imaging of the brain did not show any abnormality. Lumbar puncture showed an opening cerebrospinal fluid pressure > 40 cm H2O.

Fig 1

Right eye

Fig 2

Left eye

Questions

  • (1) What do the pictures show?

  • (2) Can you list the possible differential diagnoses?

  • (3) What would be the definitive diagnosis?

  • (4) What is papilloedema?

Answers

  • (1) Colour photographs of the optic disc of the right and left eyes, showing bilateral disc swelling, with flame shaped haemorrhages around the disc and markedly tortuous vessels, with venous engorgement.

  • (2) Raised intracranial pressure, malignant hypertension, bilateral buried drusen of the optic nerve heads, high hypermetropia, bilateral optic nerve papillitis, bilateral optic nerve tumours, Leber's optic neuropathy, bilateral simultaneous anterior ischaemic optic neuropathy, bilateral compressive thyroid ophthalmopathy.

  • (3) Idiopathic intracranial hypertension. This condition is also known as benign intracranial hypertension or pseudotumour cerebri.

  • (4) Swelling of the optic nerve head secondary to raised intracranial pressure. It is nearly always bilateral, but may be asymmetrical.

Discussion

We believe that a detailed reference to the topics of disc swelling and papilloedema is beyond the scope of this educational illustrative snapshot, as …

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