Papilloedema and optic nerve disorders

Your progress

Saved on this device.

Target exams

Red flags

• Bilateral optic disc swelling in a child is papilloedema from the raised intracranial pressure until proven otherwise, and it demands an urgent neuroimaging to exclude the space-occupying lesion, the hydrocephalus and the venous sinus thrombosis, because the delay threatens the vision and the life
• A child with the headache, the vomiting, the papilloedema and the sixth-nerve palsy has the raised intracranial pressure, and the first step is the neuroimaging before the lumbar puncture, because the lumbar puncture in the obstructed cerebrospinal fluid can cause the herniation
• The acute optic neuritis of the child with the painful visual loss and the relative afferent pupillary defect may be the first attack of the myelin oligodendrocyte glycoprotein antibody disease, the neuromyelitis optica spectrum disorder or the multiple sclerosis, and the antibody testing and the magnetic resonance imaging define the prognosis and the treatment
• The child with the venous sinus thrombosis, the otitis media or the dehydration who presents with the papilloedema has the secondary intracranial hypertension, and the cause must be sought and treated, because the idiopathic label is the diagnosis only after the secondary cause is excluded
• The intravenous methylprednisolone for the acute optic neuritis is given at twenty to thirty milligrams per kilogram per day to a maximum of one gram for three to five days, and the slower the treatment the poorer the recovery, because the untreated inflammation destroys the retinal ganglion cell axons

Life stages

Care settings

Clinical exam formats

Board mappings

• Recognises bilateral optic disc swelling as papilloedema from the raised intracranial pressure until proven otherwise, and refers the child for the urgent neuroimaging
• Names the idiopathic intracranial hypertension, formerly the pseudotumour cerebri, as the syndrome of the raised cerebrospinal fluid pressure with the normal composition and the normal neuroimaging, defined by the Friedman criteria
• Performs the swinging-flashlight test and identifies the relative afferent pupillary defect that points to the optic nerve rather than the retina as the cause of the visual loss
• Explains the Friedman diagnostic criteria and the opening pressure above two hundred and eighty millimetres of cerebrospinal fluid in the child, and distinguishes the idiopathic from the secondary intracranial hypertension
• Applies the Frisén grading of the papilloedema and the optical coherence tomography to the assessment of the severity and the response to the treatment
• Coordinates the multidisciplinary pathway for the optic neuritis, integrating the antibody testing for the myelin oligodendrocyte glycoprotein and the aquaporin-four with the magnetic resonance imaging and the intravenous methylprednisolone
• Bilateral optic disc swelling in a child is papilloedema from the raised intracranial pressure until proven otherwise, and the neuroimaging precedes the lumbar puncture, because the blind lumbar puncture in the obstructed flow can cause the herniation
• The acute optic neuritis of the child with the painful visual loss and the relative afferent pupillary defect may be the first attack of the antibody-mediated disease, and the intravenous methylprednisolone is the first-line treatment
• The idiopathic intracranial hypertension is the diagnosis only after the secondary cause is excluded, because the venous sinus thrombosis, the drugs and the infection demand the targeted treatment
• Examines the child with the swollen optic disc systematically, performing the visual acuity, the colour vision, the pupillary reactions, the fundoscopy and the visual fields, and grading the disc with the Frisén scale
• Counsels the family of the child with the idiopathic intracranial hypertension about the weight loss, the acetazolamide and the surveillance for the vision loss, and the role of the surgery in the failing vision
• Synthesises the plan for the optic neuritis that balances the acute treatment against the antibody diagnosis and the long-term immunotherapy for the neuromyelitis optica spectrum disorder and the multiple sclerosis
• Level 1: Recognition of the papilloedema and the relative afferent pupillary defect, and the urgent neuroimaging
• Level 2: Application of the Friedman criteria, the Frisén grading and the antibody testing to the diagnosis and the classification of the disc swelling and the optic neuritis
• Level 3: Coordination of the treatment and the surveillance across the idiopathic intracranial hypertension and the antibody-mediated and the demyelinating optic neuropathies
• The Friedman criteria for the pseudotumour cerebri syndrome and the opening pressure above two hundred and eighty millimetres of cerebrospinal fluid in the child
• The Frisén grading of the papilloedema and the distinction of the true papilloedema from the pseudopapilloedema of the disc drusen
• The optic neuritis of the child and the myelin oligodendrocyte glycoprotein, the aquaporin-four and the multiple sclerosis as the three aetiologies that define the recovery and the relapse
• Correct performance of the fundoscopy and the swinging-flashlight test, and the recognition of the papilloedema and the relative afferent pupillary defect
• Communication of the diagnosis of the idiopathic intracranial hypertension to the family, balancing the weight loss and the acetazolamide against the surveillance for the vision loss
• Structured examination that distinguishes the papilloedema from the optic neuritis and the pseudopapilloedema on the disc appearance, the pupillary reactions and the associated features
• Papilloedema as the bilateral optic disc swelling of the raised intracranial pressure, presenting with the headache, the vomiting and the vision loss, and demanding the urgent neuroimaging
• The diagnostic pathway from the fundoscopy and the optical coherence tomography to the magnetic resonance imaging, the magnetic resonance venography and the lumbar puncture with the opening pressure
• The optic neuritis of the child and the antibody-mediated disease, the intravenous methylprednisolone and the long-term immunotherapy for the relapsing forms
• Recognition of the bilateral optic disc swelling as the sign of the raised intracranial pressure that mandates the urgent neuroimaging
• Application of the swinging-flashlight test and the relative afferent pupillary defect in the child with the acute visual loss
• Coordination of the multidisciplinary pathway with the neurology, the ophthalmology and the neurosurgery across the intracranial hypertension and the optic neuritis
• Canadian approach to the urgent evaluation and the neuroimaging of the child with the papilloedema and the raised intracranial pressure
• The Friedman criteria and the secondary causes of the intracranial hypertension as the guides to the diagnosis and the targeted treatment
• The antibody-mediated optic neuritis and the intravenous methylprednisolone, the plasma exchange and the maintenance immunotherapy for the relapsing forms