Papilledema : Papilledema is elevation of the optic disc (the end of the optic nerve in the back of the eye) caused by increased pressure inside the skull. Grade i papilledema is the mildest stage, but any kind of increased pressure in the skull is concerning. Since the skull is made up of hard, inflexible bone, the volume of the contents of the skull is fixed. The 3 major things that are found in the skull are brain, blood, and cerebrospinal fluid. The volume of one of these things increases, the others must shrink. But they can only shrink to a point before pressure inside the skull increases. Causes of intracranial pressure can include expansion of the cerebrospinal fluid (examples include hydrocephalus and pseudotumor cerebri), expansion in blood (examples include arteriovenous malformation, or subdural hematoma), or expansion in brain (examples include brain and meningeal tumors and metastases). Most people who have ominous, life threatening causes of elevated intracranial pressure have other symptoms, and those symptoms get worse over time. A common cause of papilledema is pseudotumor cerebri. Risk factors for pseudotumor cerebri include obesity, certain medications, and certain dietary problems. Pseudotumor cerebri is probably the least serious of the possible causes of papilledema, but it can still lead to permanent vision loss. A condition called pseudopapilledema looks like papilledema but is not caused by elevated intracranial pressure. It is considered benign. Looking for causes of elevated intracranial pressure usually involves some kind of imaging of the brain (ct is slightly less expensive, MRI is better in most cases), and should include directly measuring the pressure by spinal tap (also known as lumbar puncture). Prior to doing a spinal tap, a doctor may want to check a few labs, and most doctors will send the fluid they get from the tap to the lab for routine tests. Many counties have low-cost or free medical clinics for eligible people. County medical associations and local hospitals often have lists.
Answered 10/3/2016
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