A 12-year-old boy is admitted to the emergency department with signs of meningitis. To determine the specific type of meningitis, it is necessary to aspirate cerebrospinal fluid with a lumbar puncture for laboratory examination. However, before performing a lumbar puncture, it must be established that the cerebrospinal fluid pressure is not elevated. What condition in the eye would indicate that cerebrospinal fluid pressure is too elevated for a lumbar puncture to be performed?
Papilledema is optic disc swelling ("edema of the papilla") that is caused by increased intracranial pressure and increased CSF pressure. If a lumbar puncture is performed in a patient with elevated CSF pressure and fluid is withdrawn from the lumbar cistern, the brain can become displaced caudally and the brainstem is pushed against the tentorial notch. This is a potentially fatal complication. Separation of the pars optica retinae anterior to the ora serrata, or retinal detachment, may result in vision loss or blindness. A hemorrhage from medial retinal branches may result in damage to the fovea centralis and can result in macular degeneration. Opacity of the lens (cataracts) will cause gradual yellowing and may reduce the perception of blue colors. Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated. Compression of the optic disc, resulting from increased intrabulbar pressure, will lead to an excessive accumulation of serous fluid in the tissue space.
Papilledema
Separation of the pars optica retinae anterior to the ora serrata
The foveal centralis exhibits hemorrhage from medial retinal branches.
Obvious opacity of the lens
Head & Neck