Pearls for Papilledema Management

In this 1-Minute video, Dr. Vivek Patel offers tips for managing patients with papilledema. Patients with papilledema should always be evaluated for a possible intracranial mass lesion, or could alternately have a condition such as meningitis, acute hydrocephalus or cerebral vein thrombosis. Therefore, the first step is to perform a contrast-enhanced MRI and MRV of the brain before proceeding with a lumbar puncture to measure the opening pressure and evaluate the cerebrospinal fluid. If these tests reveal elevated pressure and normal CSF constituents, following essentially normal imaging, then a diagnosis of idiopathic intracranial hypertension can be made. Always measure the patient's blood pressure to determine if their disc swelling is due to a hypertensive emergency. Diabetic papillopathy and optic perineuritis are other less common entities to consider for patients presenting with disc swelling with relatively normal visual function. 

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