Edema of the optic nerve due to increased intracranial pressure
Ophthalmology is often consulted to rule out papilledema in pts who fit the “Idiopathic Intracranial Hypertension (IIH)” profile, or with pts with other reasons for high ICP
Presentation
Symptoms of increased ICP: headaches that vary with position (often worse with bending over), nausea, vomiting, neck stiffness/meningismus, pulsatile tinnitus, fevers/chills
Visual symptoms: transient visual obscurations, dimming of vision, blurry vision, loss of color vision/red desaturation, loss of peripheral vision, scotoma
Evaluation and Management
Consult Ophthalmology and Neurology if concerned for papilledema. Neurosurgery should be involved if there is concern for shunt failure or other neurosurgical problem.
Ophthalmology / Neurology will advise on what imaging to order (usually MRI / MRV brain with and without contrast, + MRI Orbits with and without contrast and fat suppression)
If no contraindications after imaging, obtain LP with opening pressure, with CSF sent for cells, protein, glucose, and infectious/neoplastic workup where appropriate
Ophthalmology / Neurology may recommend PO or IV acetazolamide
