Background: Increasing incidence of idiopathic intracranial hypertension (IIH), overreported radiologic signs of intracranial hypertension, difficult access to outpatient neuro-ophthalmology services, poor insurance coverage, and medicolegal concerns have lowered the threshold for emergency department (ED) visits for "papilledema." Our objective was to examine referral patterns and outcomes of neuro-ophthalmology ED and inpatient consultations for concern for papilledema.
Methods: At one university-based quaternary care center, all adults referred for "papilledema" over one year underwent a standardized ED "papilledema protocol." We collected patient demographics, final diagnoses, and referral patterns.
Results: Over 1 year, 153 consecutive patients were referred for concern for papilledema. After papilledema protocol, 89 of 153 patients (58%) had bilateral optic disc edema, among whom 89% (79/89) had papilledema (intracranial hypertension). Of the 38 of 153 (25%) consultations for suspected disorder of intracranial pressure without previous fundus examination (Group 1), 74% (28/38) did not have optic disc edema, 21% (8/38) had papilledema, and 5% (2/38) had other causes of bilateral disc edema. Of the 89 of 153 (58%) consultations for presumed papilledema seen on fundus examination (Group 2), 58% (66/89) had confirmed papilledema, 17% (15/89) had pseudopapilledema, and 9% (8/89) had other causes of bilateral optic disc edema. Of the 26 of 153 (17%) patients with known IIH (Group 3), 5 had papilledema and 4 required urgent intervention. The most common diagnosis was IIH (58/79). Compared with IIH, patients with secondary causes of intracranial hypertension were older (P = 0.002), men (P < 0.001), not obese (P < 0.001), and more likely to have neurologic symptoms (P = 0.002).
Conclusion: Inpatient and ED consultations for "papilledema" are increasing. Of the 153 ED and inpatient neuro-ophthalmology consultations seen for "papilledema" over 1 year, one-third of patients with optic disc edema of unknown cause before presentation to our ED had new vision- or life-threatening disease, supporting the need for prompt identification and evaluation of optic disc edema in the ED. In the face of limited access to neuro-ophthalmologists, this study supports the need for emergency department access to expert eye-care evaluation or ocular fundus camera for prompt identification of optic disc edema and standardized evaluation for neurologic emergencies.
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http://dx.doi.org/10.1097/WNO.0000000000002120 | DOI Listing |
Mult Scler Relat Disord
December 2024
Ege University Medical School, Department of Neurology, 35100, İzmir, Turkey.
Background: The new optic neuritis (ON) classification leads to a change in how ON patients are grouped. Our aim is to appraise the clinical features and prognoses of patients with autoimmune ON not associated with MS.
Methods: Patients referred to our neuro-ophthalmology laboratory were enrolled to this retrospective study.
Zhongguo Zhong Yao Za Zhi
November 2024
School of Pharmacy, Heilongjiang University of Chinese Medicine Harbin 150040, China Jiamusi College, Heilongjiang University of Chinese Medicine Jiamusi 154007, China.
Aesculus chinensis is an important medicinal and horticultural plant. Its dried mature seeds, known as "Suoluozi", are a well-known traditional Chinese medicine. Aescins are its main active components, possessing multiple pharmacological activities such as anti-inflammatory and anti-exudative effects.
View Article and Find Full Text PDFTransl Vis Sci Technol
December 2024
Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
Purpose: Visual evoked potentials (VEPs) are electrical signals generated at the visual cortex following visual stimulation. Flash VEPs (fVEPs) are produced by global retinal stimulation and are considered an objective measure of the integrity of the entire visual pathway. However, fVEP measurements are highly sensitive to external variables, making relative comparisons of the fVEP waveforms between the two eyes in the same individual challenging.
View Article and Find Full Text PDFBMJ Case Rep
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Ophthalmology, Kasturba Medical College Mangalore, Mangalore, Karnataka, India.
Wernicke's encephalopathy, the acute phase of Wernicke-Korsakoff syndrome, is characterised as a triad of altered mental status, ocular signs and ataxia. Our patient presented with hyperemesis gravidarum, which is a rare aetiology of Wernicke's encephalopathy. The patient did not have any oculomotor abnormalities, which are more common and classically described in Wernicke's triad.
View Article and Find Full Text PDFBMJ Case Rep
December 2024
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
Non-arteritic anterior ischaemic optic neuropathy (NAION) is typically characterised by non-pallid optic disc oedema and a contralateral small optic nerve head. Typically, the optic cup is absent or small with a cup-to-disc ratio of less than 0.3 termed 'disc at risk'.
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