Papilledema: Causes, Symptoms, Diagnosis, Treatment and Complications

Often, it is a warning sign of a serious medical condition that needs attention. But sometimes the pressure and swelling can not be traced back to a specific problem.

Papilledema is the swelling of your optic disc, the place where the nerve that goes to your brain connects inside the eye. This swelling is a reaction to a buildup of pressure in or around your brain.

Papilledema is an eye condition that occurs when pressure in the brain causes the optic nerve to swell.

Papilledema can have several causes. A mild case of papilledema with symptoms that do not interrupt your life is nothing to worry about. But papilledema can be a sign of an underlying condition or injury that should be treated as soon as possible.

If not treated, papilledema can cause vision loss. This is especially true if you notice the symptoms after a major trauma to the head.

Causas de Papiledema

The network of nerves, blood and fluids of your brain fit perfectly inside your skull. Because there is a limited amount of space, when tissues swell, something grows or there is more fluid than normal, the internal pressure increases and, in turn, can cause papilledema.

The fluid that bathes the brain and spinal cord is known as cerebrospinal fluid or CSF. The swelling of the optic nerve can occur when the CSF accumulates where the optic nerve and the central vein of the retina travel between the brain and the ocular nerve.

This area is known as the subarachnoid space. When pressure pushes the nerve and vein, blood and fluid can not leave the eye at a normal rate, causing papilledema. That can happen due to:

  • A head injury
  • A tumor in the brain or spinal cord.
  • Inflammation of the brain or any of its covers, such as meningitis.
  • Extremely high blood pressure
  • Bleeding in the brain.
  • A blood clot or a problem within certain veins.
  • Pus that is collected from a brain infection.
  • Problems with the flow or amount of fluid that runs through the brain and spinal cord.

Sometimes, brain pressure increases for no apparent reason. This is known as idiopathic intracranial hypertension , which is more likely to occur if you are obese.

You may also have papilloedema as a side effect of taking or stopping some medications, which include:

  • Corticosteroids
  • Isotretinoína.
  • Lithium.
  • Tetracycline

When there is no apparent reason for high pressure inside your skull, the condition is called idiopathic intracranial hypertension (HI).

It happens to 1 in 100,000 people, but it is 20 times more likely among obese women in their childbearing years. As obesity rates increase, the HI rate also increases.

In addition, suddenly getting an additional 5% to 15% of your body weight increases the odds, regardless of your initial weight.

The exact link with being overweight is not clear. It is possible that belly fat increases the pressure in the chest and starts a chain reaction in the brain.

symptom

You may not have any symptoms at the early stage of papilledema. Your doctor may find out when you see swelling of the optic disc during a routine eye exam.

As you progress, you probably have vision problems, usually in both eyes. It is common to have blurred or double vision, and lose vision for a few seconds at a time. Other symptoms are headache, nausea and vomiting.

With IH, some of these symptoms are more noticeable. You may have a headache every day and feel it on both sides of your head. The headaches may not always be of the same intensity, but they get worse as you continue to receive them. You may hear heartbeats in your head.

Untreated papilledema can cause serious eye problems, starting with the loss of peripheral or lateral vision. In later stages, your vision may become completely blurred. Some people become blind in one or both eyes.

The first most common symptoms of papilledema are brief changes in your vision. These changes are barely noticed at the beginning, with blurry images, double vision, flashes or loss of vision that lasts a few seconds.

If the brain pressure continues, these changes may last minutes or more. In some cases, they can become permanent. The inflammation of the brain that causes papilledema triggers other symptoms that distinguish it from other eye conditions, including:

  • Feel nauseous
  • He retched.
  • Having abnormal headaches
  • Sound or other noises in the ears (tinnitus).

Diagnóstico de Papiledema

Your doctor will first perform a complete physical examination to monitor your general health and detect any other symptoms. Your doctor is likely to examine your field of vision by moving your hands back and forth beyond your eyes to see where your blind spots are.

The eye doctors use a tool called ophthalmoscope to look at each of their eyes in the optic nerve through his pupil, the opening in the front of his eye. Your doctor can diagnose a case of papilledema.

If your optic disc, which is at the end of the optic nerve, looks abnormally blurry or too high. Your doctor may also see blood spots in your eye if you have this condition and diagnose papilledema.

If your doctor thinks that a brain condition is causing papilledema, they will do additional tests such as an MRI or a CT scan of your head to check for tumors or other abnormalities in your brain and skull.

You can provide more details and possibly show what is causing the pressure in your brain. Later, magnetic resonance imaging can measure how well the treatment is working.

Your doctor may want a lumbar puncture, also called a lumbar puncture. This test measures the pressure of the cerebrospinal fluid that runs through the brain and spinal cord.

Additional tests on a sample of this fluid can help diagnose an infection or tumor. Your doctor may take a tissue sample (biopsy) from the tumor to look for cancer cells or drain part of the cerebrospinal fluid to look for abnormalities.

Papiledema treatment

If the tests reveal a medical problem, treating it should also cure the papilledema. For example, you may need antibiotics for a brain infection, surgery to drain an abscess or remove a tumor or drugs to dissolve a blood clot.

Your doctor can change a problematic medication.

Otherwise, your symptoms will probably guide your treatment. With mild papilledema and no symptoms, your doctor may simply continue to check and test regularly for any vision problems as soon as possible.

For mild vision loss, the usual treatment is to lose weight and take a diuretic called acetazolamide. This medicine helps reduce the pressure inside your head by decreasing the amount of fluid in your body and the amount of fluid your brain produces.

When you are overweight, losing only 5% to 10% of your body weight can improve symptoms and sometimes even cure papilledema. If you are having difficulties, ask your doctor if you could be a candidate for weight loss surgery.

You can take an analgesic for your headaches. Topiramate (Topamax), used for migraines and attacks, also helps some people lose weight and decreases the pressure inside the skull.

The removal of some spinal fluid often relieves pressure and symptoms. Sometimes, only the fluid needed for testing is enough to make a difference. Or your doctor may want to make regular spinal punctures to reduce the pressure.

If your vision gets worse despite all these efforts, there are different types of brain surgery to relieve pressure and protect your optic nerve. Unless your doctor finds a specific cause and treats it successfully, the papilledema can return.

Your doctor may perform a lumbar puncture, also called a spinal tap, to drain extra fluid from your brain and reduce swelling. Your doctor may also prescribe acetazolamide (Diamox) to keep the nervous system pressure at a normal level.

If being overweight or obese causes papilloedema, your doctor may recommend a weight loss plan and a diuretic, which can help reduce the pressure inside your head.

Your doctor may prescribe medications to reduce swelling. Corticosteroids, such as prednisone (Deltasone), dexamethasone (Ozurdex), and hydrocortisone (Cortef), can be used to keep the swelling in the brain. These medications can be injected or taken by mouth.

If high blood pressure is causing papilledema, your doctor may prescribe medications to keep your blood pressure under control. Common medications for high blood pressure include:

Diuretics : bumetanide (Bumex) and chlorothiazide (Diuril).

Beta blockers : atenolol (Tenormin) and esmilol (Brevibloc).

ACE inhibitors : captopril and moexipril.

If you have a brain tumor, your doctor may recommend surgery to remove part or all of the tumor, especially if the tumor is cancerous. Radiation or chemotherapy can also help the tumor get smaller and reduce swelling.

If an infection is causing your papilledema, your doctor may prescribe antibiotics. The medications for the infection differ depending on the type of bacteria that is causing the infection.

If you have an abscess, your doctor may use a combination of antibiotics and drainage to treat a possible infection, as well as to remove pus or infected fluid from your brain.

If you have just had a major head injury, your doctor will try to reduce the pressure and swelling in your head. This may involve draining the cerebrospinal fluid from the head and removing a small piece of your skull to relieve pressure.

Is There Any Possible Complication?

Papilledema can cause blindness if the pressure continues for a long time without treatment, even if there is no underlying condition. Other complications of untreated papilledema related to the conditions that can cause it include:

  • Brain damage.
  • Strokes
  • Convulsions
  • Constant headaches.
  • Death.

Papilledema is not usually a problem in itself. In general, it can be treated by draining extra cerebrospinal fluid, which reduces swelling. The symptoms disappear in a few weeks.

The swelling or injury to the brain can be serious and life threatening. If the papilledema is caused by an underlying condition, get treatment right away to prevent long-term complications.