Pseudopapilledema [Neurosurgery Wiki]

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====== Pseudopapilledema ======


Pseudopapilledema refers to an abnormal appearance of the [[optic disc]] that mimics true [[papilledema]] (optic disc swelling due to increased intracranial pressure), but it is not caused by elevated [[intracranial pressure]] or true optic nerve edema.

===== 🔍 Key Features: =====

Cause: Most commonly due to optic disc drusen (calcified deposits) or congenitally small scleral canal.

Appearance: Optic disc appears elevated or swollen, often with blurred margins.

Visual Function: Usually preserved, though [[visual field defect]]s (especially peripheral) can occur over time with drusen.

Imaging: B-scan ultrasound, fundus autofluorescence, or OCT ([[optical coherence tomography]]) can help differentiate from true papilledema.

Important Note: Misdiagnosis can lead to unnecessary neuroimaging or lumbar puncture.

| Feature                  | Pseudopapilledema                              | True Papilledema                                  |
|--------------------------|------------------------------------------------|----------------------------------------------------|
| **Cause**               | Optic disc drusen, small scleral canal         | Increased intracranial pressure (ICP)             |
| **Disc Appearance**     | Elevated disc with blurred margins             | Elevated disc with blurred margins, hyperemia     |
| **Spontaneous Venous Pulsations** | Often present                            | Usually absent                                     |
| **Hemorrhages/Exudates**| Rare                                           | Common (especially flame hemorrhages)             |
| **Visual Function**     | Usually normal; possible peripheral defects     | May be affected if prolonged or severe            |
| **Laterality**          | Often bilateral; can be asymmetric              | Usually bilateral and symmetric                   |
| **OCT (RNFL Thickness)**| Elevated, stable over time                     | Elevated, may change over time                    |
| **Fundus Autofluorescence** | May reveal drusen                          | Typically normal                                   |
| **Ultrasound (B-scan)** | Highly reflective drusen visible               | Normal or thickened nerve                         |
| **Need for Neuroimaging**| Not required if diagnosis is certain           | Always required to rule out serious causes        |
| **Treatment**           | Usually none                                   | Depends on underlying cause (e.g. IIH, tumor)     |