Severe Papilledema Identified 3 Weeks After Head Injury. Case Report.

Abstract

A 62-year-old woman presented with rapidly developed visual disturbance without associated headache or nausea 3 weeks after head injury. Ophthalmologic examination revealed bilateral severe papilledema with retinal hemorrhage, and intracranial pressure (ICP) was 17.5 cmH 2 O estimated by lumbar puncture. Computed tomography and magnetic resonance (MR) imaging showed no evidence of increased ICP, except dilation of the subarachnoid space around the optic nerves with distortion of the nerves. Her visual acuity remarkably improved after steroid and glycerol treatment, and optic fundus examination revealed bilateral clear optic papillae without atrophic changes. Follow-up MR imaging demonstrated that the bilateral optic nerves had regained the normal appearance. These results indicate that the bilateral papilledema was caused by increased subarachnoid pressure around the bilateral optic nerves. We conclude that papilledema can occur with a mildly increased ICP and trapped subarachnoid cerebrospinal fluid around the optic nerves, and papilledema may progress after the ICP is normalized. Papilledema is a warning sign for increased ICP, associated with future visual loss from retinal hemorrhage. Therefore, repeated funduscopic investigation is necessary for the early diagnosis and treatment of papilledema.

Clinical Profile of Ocular Involvement In Head Injury

“…It is consistent with findings of MasilaEtal [8] Papilloedema is generally due to secondary manifestations of cerebral injury producing raised intracranial tension. This is well co-related withYadama SM ,etal [14] who reported that papilloedema may occur due to mildly raised ICP and trapped subarachnoid CSF around the optic nerve.kulkarny et al [1] reported 5.8% incidence of papilloedema. Pre retinal Hemorrhage and Vitreous hemorrhage was seen in 4% and 1% cases respectively.It was almost similar as in other studies.…”

Papilledema in chronic subdural hematoma: how often it is seen and what has changed?

“…Over the two recent decades, there have been anecdotal reports on bilateral papilledema in patients with CSDH [19,20,21]. Bilateral papilledema in patients with CSDH may be caused by an increased gradient of pressure between the subarachnoid space around the bilateral optic nerves and the intracranial subarachnoid space [15]. The difference in age structure of the study sample and early diagnosis of CSDH are likely to explain the difference in the reported incidence of papilledema in patients with CSDH between studies.…”

“…Studies vary in the reported incidence of papilledema in patients with CSDH. It has been reported that the incidence of papilledema in patients with CSDH in the studies conducted before the nineteen nineties ranged from 20% to 75% [11][12][13][14][15][16], and in more recent studies was as low as 0.4%-2% [17,18]. Over the two recent decades, there have been anecdotal reports on bilateral papilledema in patients with CSDH [19,20,21].…”