Khaled Mahmoud

 What Is Papilledema? What Is Papilledema? Papilledema is a serious medical condition where the optic nerve at the back of the eye becomes swollen. Symptoms can include visual disturbances, headaches, and nausea. Papilledema occurs when there is a buildup of pressure in or around the brain, which causes the optic nerve to swell. It is critical to identify the cause of papilledema, which can be life-threatening. It can occur in one or both eyes. This article will outline what papilledema is, as well as its symptoms and how it can be treated. Fast facts on papilledema: The condition is treated in different ways, depending on its cause. If left untreated, permanent damage to vision can occur. A serious problem in the brain can swell the optic nerve, with headaches and visual changes resulting. Symptoms of Papilledema: Symptoms related to papilledema caused by increased pressure include headache and nausea with vomiting and a machinery-like sound. Twenty-five percent of people with advanced severe papilledema also will develop some visual symptoms. Typically, the visual changes are recurring brief episodes lasting less than 30 seconds in which the vision turns gray or blacks, sometimes described as if a veil has fallen over the eyes. The symptoms usually affect both eyes at once. Visual blackouts often are triggered by a change in position, such as by standing up very suddenly, or they may be triggered by coughing or straining in the chest or abdomen. Occasionally, people with papilledema can have an experience of flashing lights, often seen in an arc shape. Other visual changes occur over time, including a smaller field of vision with a larger blind spot and, ultimately, blindness, if successful treatment is not given. Causes of Papilledema The optic nerve is a bundle of fibers that transmits visual information between the retina and the brain. The area where the optic nerve enters the back of the eyeball is known as the optic disc. The brain and optic nerve are surrounded by cerebrospinal fluid (CSF), which helps to keep them stable and protected from damage from sudden movements. Papilledema occurs when increased pressure from the brain and cerebrospinal fluid is placed on the optic nerve. This causes the nerve to swell as it enters the eyeball at the optic disc. There are some serious medical conditions that can cause this increased pressure to develop, including: head trauma inflammation of the brain or surrounding tissue severely high blood pressure, known as a hypertensive crisis infection in the brain brain tumor bleeding in the brain blockages of blood or cerebrospinal fluid in the brain abnormalities of the skull Idiopathic intracranial hypertension (IIH) describes a rare condition where the body produces too much cerebrospinal fluid. This leads to increased pressure in the brain. Symptoms of IIH usually include headaches, visual disturbances, and ringing in the ears. The exact cause of this condition is unknown and is not related to any brain disease or injury. IIH often affects younger, obese females. It can also be associated with medications, such as lithium, certain antibiotics, thyroid hormone treatment, and corticosteroids. Papilledema and Chronic Diseases Intracranial hypertension is a condition due to high pressure within the spaces that surround the brain and spinal cord. These spaces are filled with cerebrospinal fluid (CSF), which cushions the brain from mechanical injury, provides nourishment, and carries away waste. The most common symptoms of intracranial hypertension are headaches and visual loss, including blind spots, poor peripheral (side) vision, double vision, and short temporary episodes of blindness. Many patients experience permanent vision loss. Other common symptoms include pulsatile tinnitus (ringing in the ears) and neck and shoulder pain. Intracranial hypertension can be either acute or chronic. In chronic intracranial hypertension, the increased CSF pressure can cause swelling and damage to the optic nerve—a condition called papilledema. Chronic intracranial hypertension can be caused by many conditions including certain drugs such as tetracycline, a blood clot in the brain, excessive intake of vitamin A, or brain tumor. It can also occur without a detectable cause. This is idiopathic intracranial hypertension (IIH). Because the symptoms of IIH can resemble those of a brain tumor, it is sometimes known by the older name pseudotumor cerebri, which means “false brain tumor.” Complications of Papilledema Papilledema can cause blindness if the pressure continues for a long time without being treated, even if there isn’t an underlying condition. Other complications of untreated papilledema related to the conditions that can cause it include: brain damage stroke seizures constant headaches death Disease Process (How It Arises) As the optic nerve sheath is continuous with the subarachnoid space of the brain (and is regarded as an extension of the central nervous system), increased pressure is transmitted through to the optic nerve. The brain itself is relatively spared from pathological consequences of high pressure. However, the anterior end of the optic nerve stops abruptly at the eye. Hence the pressure is asymmetrical and this causes a pinching and protrusion of the optic nerve at its head. The fibers of the retinal ganglion cells of the optic disc become engorged and bulge anteriorly. Persistent and extensive optic nerve head swelling, or optic disc edema, can lead to loss of these fibers and permanent visual impairment. Can Papilledema benefit from diet or lifestyle changes? The authors hypothesized that a metformin (MET)-diet would improve symptoms of idiopathic intracranial hypertension (IIH) in women who also had polycystic ovary syndrome (PCOS) or hyperinsulinemia without PCOS. Changes in weight, papilledema, headache, visual fields, and overall life status were prospectively assessed in response to 6 to 14 months on 2.25 g/day MET-diet or diet alone in 36 women with IIH, 23 with PCOS, selected by baseline body mass index (BMI) > or = 25, and no previous surgery for IIH. Overall life status was graded using a self-reported 1-5 scale (1 = well, normal activities; 2 = unwell, usual activities; 3 = poor, usual activities; 4 = poor, no usual activities; 5 = totally disabled). Conventional treatment for IIH was maintained unchanged during MET-diet intervention. The diet was hypocaloric (1500 calories/day), high protein (26% of calories), and low carbohydrate (44%). Of the 23 women with PCOS, 20 received MET-diet and 3 diet only (could not tolerate MET). Of the 13 women without PCOS, 7 were hyperinsulinemic and received MET-diet and 6 received diet alone. The 3 treatment groups (diet only [n = 9], PCOS-MET-diet [n = 20], and hyperinsulinemia-MET-diet [n = 7]) did not differ by median entry BMI (33.3, 37.6, and 35.7 kg/m(2)) or by duration of treatment (10.2, 11.4, and 10.9 months). Median percent weight loss was greatest in the PCOS-MET group (7.7%, P = 0.0015), was 3.3% in the diet only group, and 2.4% (P = 0.04) in the hyperinsulinemia-MET group. Papilledema significantly improved in the diet-alone group from 100% at baseline to 13% (P = 0.03), and in the PCOS-MET group from 95% to 30% (P = 0.002). If headache persisted on therapy, it was less intense-less frequent (P = 0.03) in the diet-only group and in the PCOS-MET group (P = 0.04). As many women with IIH have PCOS, and because weight loss is central to IIH treatment, diet-MET is a novel approach to treat IIH in women with concurrent PCOS or hyperinsulinemia without PCOS. Diagnosis Diagnosis typically involves a tool called an ophthalmoscope, an instrument resembling a pen with a lighted wheel at the tip. The ophthalmoscope is used to inspect the back portion of the eye through the pupil. This may require a dilated eye where drops are placed in the eye to force the pupil to become larger. A doctor will assess the optic disc for any abnormalities, such as it having been pushed out of position or appearing more blurred than normal. These changes can indicate that the optic nerve is swollen. In more severe cases, spots of blood may appear on the retina. Tests can also be done to assess any changes in color vision, losses of vision, or double vision, along with visual accuracy assessments. If signs of papilledema are detected, brain-imaging scans will be needed. These can include magnetic resonance imaging (MRI) or computed tomography (CT). Blood tests and a lumbar puncture or test that takes a sample of cerebrospinal fluid from the spinal canal may also be necessary. In all instances, it is vital to determine the reasons for an increase in pressure that affects the brain. Treatment: The choice of treatment of papilledema depends upon its cause. If a brain tumor is diagnosed, a biopsy (by surgery) may be required as the first step to treatment. Brain tumors sometimes can be treated with a form of laser treatment or radiation and often require surgery. High blood pressure should be managed as an emergency in the hospital if it results in papilledema. Idiopathic intracranial hypertension can be treated with repeated spinal taps to remove excess spinal fluid, or with a medication called acetazolamide (Diamox and other brand names). This medicine causes the body to make less cerebral spinal fluid and returns the central nervous system's pressure to normal. Weight loss is encouraged and is helpful. A few patients will require surgery to help extra spinal fluid drain if they do not do well with initial treatment. Because idiopathic intracranial hypertension is often a long-lasting condition that has the potential to damage vision, monitoring by an ophthalmologist is an important part of the treatment. Long Term Outlook apilledema isn’t usually an issue on its own. It can typically be treated by draining extra CSF fluid, which reduces swelling. Symptoms then disappear in a few weeks. Swelling or injury to your brain can be serious and life-threatening. If papilledema is caused by an underlying condition, get treated right away to prevent any long-term complications