Papilledema : "What the radiologist needs to know"

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2017

Poster Number:

C-0782

Type:

Educational Exhibit

Keywords:

Patterns of Care, Oedema, Cerebrospinal fluid, Education, Contrast agent-intravenous, Angioplasty, Catheter venography, MR-Angiography, MR, Neuroradiology peripheral nerve, Eyes, CNS

Authors:

G. Kim¹, S. K. Kim², W. Yoon², B. H. Baek², Y. Y. Lee¹; ¹Gwang ju/KR, ²Gwangju/KR

DOI:

10.1594/ecr2017/C-0782

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-0782

Fig. 1: Fundoscopic findings of normal and papilledema patients.

Fig. 2: Schematic drawing of normal CSF circulation and pathomechanism of papilledema

Fig. 3: Schematic drawing of changes of eyeballs and optic nerve in papilledema patient.

Fig. 4: MR images of normal optic nerve sheath (A) and widened optic nerve sheath (B)...

Learning objectives

♠The purpose of our educational exhibit is to: Review key anatomical structures, pathologic mechanism and clinical implication of papilledema Describethe key MRI findings of papilledema Review several causes of increased intracranial pressureand papilledema, with some cases. Emphasize the role of transverse venous sinus stenting in patients with idiopathic intracranial hypertension and transverse sinus stenosis.

Background

1.Definition of papilledema Optic disc swelling associated with increased intracranial pressure (ICP) 2. Fundoscopic findings of papilledema(Fig.1) Optic disc swelling with blurred margin Disc hyperemia Peripapillary hemorrhage Venous engorgement 3. Key anatomic structures associated with papilledema Perioptic meninges - Envelope the length of the optic nerve up to the globe and continuous with intracranial meninges Subarachnoid space of the optic nerve - Multichambered tubular system with blind end behind the globe and connected with cranial subarachnoid space - ICP change can be transmitted to the...

Findings and procedure details

♠ Key MR imaging findings of papilledema 1. Widening of optic nerve sheath Normal optic nerve sheath - Diameter Just behind the globe: 5.52± 1.11 mm 4 mm posterior to the globe : 5.2 ± 0.9 mm Bulbous appearance at just behind the globe - Most distensible part of the optic nerve sheath Diameter of optic nerve sheath is a strong indicator of increased ICP Optic nerve sheath enlargement in papilledema (Fig.4, 5) - Appears as widened ring of CSF around an optic nerve on...

Conclusion

♠ Summary Papilledema is optic disc swelling associated with intracranial pressure (ICP) Early detection of papilledema is important because it could be indicator of increased ICP and could lead to visual impairment and even blindness by itself There are some key MRI findings which represent the papilledema 1) Widening of optic nerve sheath 2) Flattening of posterior sclera 3) Optic disc protrusion into globe 4) Tortuosity of optic nerves There are some etiologies which could cause the papilledema 1) Increased blood volume 2) Increased CSF...

Personal information

References

1. Passi N, Degnan AJ, Levy LM. MR imaging of papilledema and visual pathways: effects of increased intracranial pressure and pathophysiologic mechanisms. AJNR Am J Neuroradiol 2013;34:919-924 2. Degnan AJ, Levy LM. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 2011;32:1986-1993 3. Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, et al. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol 2011;32:1408-1414 4. Jinkins...