Posted by firstname.lastname@example.org - Posted on 03/07/2015 01:31:37 Neuro ophthalmology
54 year old presented with blurred vision. Optic disc examination revealed the following in both eyes. What is the diagnosis? What one investigation you want to order?
The optic disc appears to be elevated above the level of the surrounding retina along with blurred disc margins and dilated blood vessels. This patient has papilledema , a condition that represents elevated intracranial pressure. This patient will need an MRI of the brain to find the etiology of the elevated intracranial pressure. True papilledema should be differentiated from psuedopapilledema cases most important being optic disc drusen. Disc drusen may present with elevated disc and blurred margins. However, the blood vessels at the disc margin are distinct and not blurred or obscured. There is absence of hyperemia or hemerrahges on the disc surface. B scan: Calcification seen in these cases will allow for it to be highly reflective on B-scan ultrasonography and remain highly reflective even when the signal intensity is decreased. CT scan (not MRI): would be able to demonstrate the calcium. FA: Areas of focal blockage early in the angiogram and late staining without leakage is seen in dis drusen, whereas papilledema will have early hyperflourescence and late leakage. Superficial disc drusen will demonstrate autofluorescence