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 defects (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) |