Picture quiz Disc swelling or papilloedema?
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.
If the compression is caused by raised intracranial pressure then the condition is termed papilloedema and is almost universally bilateral. There are various causes of papilloedema, the most common being hydrocephalus, intracranial tumours (primary or metastatic), idiopathic intracranial hypertension, subdural and epidural haematomas, subarachnoid haemorrhage, arteriovenous malformations, cerebral venous thrombosis, and infectious diseases (meningitis, encephalitis, brain abscess).3
As our case refers to idiopathic intracranial hypertension, we will concentrate on