|Year : 1982 | Volume
| Issue : 5 | Page : 465-467
K Vengala Rao, M Subrahmanyam, B Subba Rao
Deptt. of Ophthalmology, Guntur Medical College, Guntur, India
B Subba Rao
Deptt. of Ophthalmology, Guntur Medical College, Guntur
|How to cite this article:|
Rao K V, Subrahmanyam M, Rao B S. Papilloedema. Indian J Ophthalmol 1982;30:465-7
One of the most fascinating and perplexing problems of Neuro-Ophthalmology is the aetiological diagnosis and management of papilloedema. Papilloedema is one of the most common conditions an ophthalmologist comes across very frequently in his routine clinical practice. The ophthalmologist has a vital role in differentiating papilloedema from pseudoneuritis, in confirming the diagnosis and in advising the time of surgery and in giving the prognosis as far as vision is concerned. In this paper an attempt has been made to study papilloedema in all its aspects. This study has been possible because of the close co-operation of department of Ophthalmology and Neurosurgery.
| Materials and methods|| |
All patients who attended with the complaint of cephalagia or defective vision were examined routinely for determination of visual acuity, fundus examination by direct ophthalntoscopy, and for patients having papilloedema, peripheral and central fields were taken. Cases that were first seen in the department of Neuro-Surgery were also examined in the department of ophthalmology.
Investigations like plain X-Ray skull, carotid angiography and Ventriculography were done routinely to detect space-occupying lesions. When these were normal, C.S.F. analysis was done to exclude infections like meningitis. If it was also normal, the case was considered as benign intracranial hypertension.
The treatment consisted of medical management with systemic steroids and oral glycerol during the period of investigation of the patient. When a space occupying lesion was diagnosed, ventriculoperitoneal shunt, followed by suboccipital craniectomy, craniotomy and excision of tumor, abscess drainage were performed in suitable patients. I hese were referred for radiotherapy to centres having necessary facilities, when indicated.
| Observations|| |
Out of the 110 cases, 64 were males and 46 were females. 18 cases occurred in the first decade, 28 cases each in 2nd and 3rd decades; 8 each in 5th decade and 6th decade and 20 in 4th decade, above. 52% of cases occurred in the second and third decades of asze and only 15% in the 5th decade or above.
The duration of illness was less than one month in 28 cases, 1 to 3 months in 36; 4 to 6 months in 12; 6 months to one year in 5 and were more than 1 year in 17 cases.
Headache was the commonest symptom (85%) and usually preceded vomitings which occurred in 56% of cases. Fall of vision to 6/24 to 6/60 was found in 2 cases and 6/60 to HM in 15 cases. Fundus examination revealed bilateral papilloedema in 92 cases, (83%), unilateral papilloedema in one and post papilloedaemic optic atrophy in 17 cases (16%). It was found that a cases of frontal tumors, 2 cases of brain abscess, and I temporal lobe tumor seen during the same period did not reveal papilloedema. Rath et all in a retrospective study of intracranial space-occupying lesions, found that 5.6% of cases did not have papilloedema. They reported other studies wherein 11.7 to 40.5% of cases of intracranial tumours without papilloedema occurred. Absence of papilloedema in an otherwise suspected case is no surety that the patient is not suffering from intracranial space occupying lesion. In 21 cases (19%) convulsions were present. Neurological signs of localizing value were detected in 69 cases (62.1%) [Table - 1] plain X-Ray of skull was abnormal in only 23 out of 73 cases of intracranial space occupying lesions.
Out of 110 cases, 18 cases were incompletely investigated, 16 were due to benign intracranial hypertension and 21 were due to tuberculous meningitis, and the rest were due to space occupying lesions [Table - 2].
Out of the 73 patients with intracranial space-occupying lesions, 37 (50%) subjected themselves for surgery. Of these histopathological examinations revealed that 5 were meningionas 7 astrocytomas, 4 accoustic neurinomas, and 3 as epindymomas, 4 abscesses and one case of subdural haematoma.
There were 22 deaths (19.8%) of which 11 died before any definitive treatment could be given. There were 1 I deaths after surgery, 6 after craniotomy and 5 following ventriculoperitoneal shunt.
We may conclude that 85% of cases occurred in people less than 40 yeats of age. 50% of cases occurred in second and third decades. Duration of illness was less than 6 months in 69% and less than 3 months in 58%. Bilateral papilloedema was seen in 83% and post papilloedemaimic optic atrophy in 16%. Visual acuity of less than 6/24 was seen in only 16% of cases. The commonest field defect was enlargement of blind spot (64%). Concentric contraction of field was seen in 10%. Fields could not be recorded in 26% 7 due to poor visual acuity or ill health. History of transient obscurations of vision was present in 20%. Localising neurological signs were present in 62.1 %. Plain X-Ray of skull was useful only in 31.5%. Papilloedema was seen only in 55 cases out of 73 cases of intrarcanial space occupying lesions (76%). Frontal lobe tumors were the commonest intra cranial tumors. (25 out of 73.34%). In only 64% of them papilloedema was present. With tumors in and around the ventricles, papilloedema occurred in all the cases. Tuberculous meningitis with hydrocephalus was the commonest cause of papilloedema.
| Summary|| |
An analysis of signs, symptoms, etiology and the treatment of 110 cases of papilloedema was made. It was found to be common in second and third decades, Post-papilloedaemic optic atrophy and gross fall of vision were noted in 16-. Localising neurological signs were present in 62.1-. Plain X-Ray was of some use only in one out of 3 cases. Frontal lobe tumor was the commonest intracranial tumor. Tuberculous Meningitis with hydrocephalus was the commonest cause of papilloedema.
| References|| |
|1.||Duke Elder, S., 1970, "System of Ophthalmology, Vol II Henry Kimpton, London. |
|2.||Mathi K.V., 1978, Neurology, India, 26:157. |
|3.||Rath, S. Das, B.S., Kar, C., Sahoo, V.K., 1978 Neurology India, 143, |
|4.||Walsh, 1957, Clinical Neuropalmology, Baltimore. |
[Table - 1], [Table - 2]