Which of the following is an early sign of papilledema?
Loss of Spontaneous Venous Pulsations is amongst the earliest signs of papilloedema. It is however not specific because up to 10-20% normal eyes may not exhibit spontaneous venous pulsations. Please note: Loss of spontaneous venous pulsations is the first sign of raised intracranial tension and hence papilledema. This is used as a sign to identify papilledema in young children as disc edema usually does not manifest in that age due to pliable cranial suture. (Fenichel's Clinical Pediatric Neurology, 7th edition, A Signs and Symptoms Approach - Chapter 4: Increased Intracranial Pressure, 2013, Pages 89-112) Feature Papilloedema 1. Laterality Usually bilateral 2. Symptoms Visual acuity Transient attacks of blurred vision, later vision decreases due to optic atrophy Pain and tenderness Absent 3. Fundus Examination Media Clear Disc-colour Red and juicy Appearance Disc-margin Blurred Disc-swelling 2-6 dioptres on Direct Ophthalmoscopy Peripapillary oedema Present Venous engorgement More marked Retinal haemorrhages Marked Retinal exudates More marked Macula Macular star may be present 4. Fields Enlarged blind spot 5. Fluorescein Angiography Ventricular oval pool of dye due to leakage Cupping of disc- seen in glucomatous changes Cotton wool spots-seen in retinsl nerbve fiber layer (2nd) in pregnancy induced Retinopathy
Loss of pulsations
Cupping of disc
Blurring of disc margin
Cotton wool spots
Neuro Ophthalmology