====== Papilledema Differential Diagnosis ======

===== Latest PubMed Articles =====


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[[Papilledema]] refers to optic disc swelling due to increased [[intracranial pressure]] (ICP). However, when optic disc edema is noted, it's crucial to distinguish true papilledema from other causes of disc swelling. 

===== Structured differential diagnosis =====


==== 🔴 True Papilledema (due to increased ICP) ====

Caused by elevated pressure in the cerebrospinal fluid (CSF):

Intracranial Mass Lesions
Tumors (gliomas, metastases, meningiomas)

Abscesses

Hematomas

Cerebral Edema
Trauma

Hypoxic-ischemic injury

Hypertensive encephalopathy

Hydrocephalus
Obstructive (e.g., aqueductal stenosis)

Communicating (e.g., post-meningitic)

Idiopathic Intracranial Hypertension (IIH)
Especially in young obese females

Cerebral Venous Sinus Thrombosis
May mimic IIH

Meningitis/Encephalitis
Infectious or inflammatory processes causing brain swelling

==== ⚠️ Disc Edema NOT Due to Raised ICP ====

Unilateral or Bilateral[[ Optic Neuritis]]

[[Multiple sclerosis]]

[[Neuromyelitis optica]] (NMOSD)

MOG-antibody associated disease

Ischemic Optic Neuropathy

Non-arteritic (NAION): common in elderly, associated with vascular risk

Arteritic (AAION): e.g., [[giant cell arteritis]]

Infiltrative or Neoplastic Optic Neuropathy

[[Lymphoma]]

[[Leukemia]]

[[Sarcoidosis]]

Toxic/Nutritional Optic Neuropathy

[[Methanol]], [[ethambutol]]

[[Vitamin B12]] deficiency

Congenital [[Pseudopapilledema]]

[[Optic disc drusen]]

Hypermetropic crowded discs

Other Mimickers

Papillophlebitis (in young patients with retinal vein congestion)

[[Uveitis]] (posterior)

Hypertensive retinopathy (Grade IV with disc edema)

==== 🧪 Workup ====

Neuroimaging: MRI/MRV to rule out mass lesion, thrombosis

Lumbar Puncture: Measure opening pressure, CSF analysis (after imaging)

OCT: Assess retinal nerve fiber layer thickness

Visual fields: Enlargement of blind spot common in papilledema

Fundus autofluorescence/ultrasound: To detect optic disc drusen

====== Review ======

A comprehensive [[review_article]] by Susan P. Mollan offers a timely update on the diagnosis and management of [[papilledema]], a condition characterized by bilateral optic disc swelling due to raised [[intracranial_pressure|intracranial pressure]]. The article is particularly relevant in the context of increasing cases of [[idiopathic intracranial hypertension]] (IIH), strongly correlated with the global rise in [[obesity]]
((Mollan SP. Papilledema. Continuum (Minneap Minn). 2025 Apr 1;31(2):436-462. doi: 10.1212/CON.0000000000001556. PMID: 40179403.))

A standout strength of this review lies in its emphasis on differentiating true [[papilledema]] from [[pseudopapilledema]], a common diagnostic pitfall. The discussion on the role of [[optical coherence tomography]] (OCT) is especially valuable. The inclusion of recent imaging biomarkers and structural OCT changes improves clinical accuracy in distinguishing optic disc edema from congenital anomalies like buried optic nerve head drusen.

The article also highlights the multidisciplinary nature of papilledema care. Effective management relies on collaboration between [[ophthalmologist]]s and [[neurology|neurologists]], with shared responsibilities in both diagnosis and treatment—especially crucial when symptoms such as [[visual field defect]]s and chronic [[headache]] are present.

However, the review could have benefitted from a more in-depth exploration of emerging therapies for cerebrospinal fluid (CSF) regulation. Although newer treatment pathways are mentioned, details on pharmacologic or surgical innovations are limited. Further commentary on the role of [[neuroimaging]] advancements, particularly with high-resolution MRV (magnetic resonance venography), would have added a more complete clinical picture.

In conclusion, this article is an essential read for any clinician managing patients with suspected raised intracranial pressure. It combines updated diagnostic strategies with practical insights into team-based care, although it leaves room for more discussion on therapeutic frontiers.
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Difficulties occur in the [[differential diagnosis]] of [[papilledema]] against similar changes of the [[optic nerve]] head seen during [[ophthalmoscopy]]
((Serova NK, Eliseeva NM. Zastoinyi disk zritel'nogo nerva kak priznak vnutricherepnoi gipertenzii [Papilledema as a sign of intracranial hypertension]. Vestn Oftalmol. 2022;138(4):87-93. Russian. doi: 10.17116/oftalma202213804187. PMID: 36004596.))
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Causes of papilledema include [[intracranial tumor]]s, [[idiopathic intracranial hypertension]] (pseudotumor cerebri), [[subarachnoid hemorrhage]], [[subdural hematoma]] and intracranial [[inflammation]]. [[Optic disc edema]] may also occur from many conditions other than papilledema, including central retinal artery or vein occlusion, congenital structural anomalies, and [[optic neuritis]]
((Whiting AS, Johnson LN. Papilledema: clinical clues and differential diagnosis. Am Fam Physician. 1992 Mar;45(3):1125-34. PMID: 1543098.)).

===== References =====