|Year : 1983 | Volume
| Issue : 5 | Page : 577-580
Fluorescein angiography in pseudopapilledema
J Agarwal, MK Mehra, PK Agrawal, VB Pratap, Dipak Kumar
Department of Ophthalmology, K.G's. Medical College, Lucknow, India
Department of Ophthalmology, K.G's. Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwal J, Mehra M K, Agrawal P K, Pratap V B, Kumar D. Fluorescein angiography in pseudopapilledema. Indian J Ophthalmol 1983;31:577-80
|How to cite this URL:|
Agarwal J, Mehra M K, Agrawal P K, Pratap V B, Kumar D. Fluorescein angiography in pseudopapilledema. Indian J Ophthalmol [serial online] 1983 [cited 2020 Feb 21];31:577-80. Available from: http://www.ijo.in/text.asp?1983/31/5/577/36594
Excluding the presence of papilledema in doubtful cases can often be one of the most perplexing conditions which both the ophthalmologist and the neurologist have to face, as spurious swellings of optic nerve head may simulate the picture of true disc oedema. In these cases, fluorescein angiography has been done to evaluate its utility.
| Material and Methods|| |
14 cases who either attended ophthalmic O.P.D. or were referred from neurology and paediatric departments of King George's Medical College, Lucknow, were included in this study. In these cases, history and fundus examination raised a doubt of the presence of papilledema. Detailed history of patients was taken. Vision, refraction, field charting and X-ray skull were done to find out any sign, favouring papilledema. As these investigations were inconclusive, the patients were subjected to fluorescein angiography.
| Observations|| |
With the help of fluorescein angiography, 8 cases out of total 14 cases were detected as pseudopapilledema while in 6 cases, early papilledema was diagnosed.
There were 4 cases who presented with similar complaints as in raised intracranial tension and fundus examination in all the cases was suggestive of doubtful early papilledema. In case No. 3 there was peripheral constriction of fields while in case No. 4, left VIII nerve was involved and C.P. angle tumour was being suspected.[Table - 1]
Fluorescein angiography in all these cases excluded the presence of papilledema due to the absence of leakage of dye. The cause of false appearance of the disc was considered as myopic astigmatism in case No. 1 [Figure - 1],[Figure - 2],[Figure - 3], hypermetropia in cases No. 2 and 3 and in case No. 4 as hypermetropic astigmatism.
Marked dilatation and tortuosity of vessels and hyperaemia of the disc were responsible for pseudopapilledema in 2 cases. In one case papilledema due to secondaries from Rt. Tonsil was being considered but fluorescein angiography proved it as false appearance due to lens sclerosis. In a female, excessive glial tissue was responsible for pseudopapilledema.
Out of doubtful cases, 6 were proved as a true early cases of papilledema. Symptoms in these cases were more or less same as in pseudopilledema and disc appearance was also same in form of hyperaemic discs, blurred margins, cup indistinct and dilated vessels. But fluorescein angiography revealed definite leakage of dye beyond the disc margins and increased number of capillaries on the disc surface.
| Discussion|| |
Often, it becomes difficult to ascertain on the basis of fundus examination that whether we are dealing with an early case of true disc oedema or the appearance is false, i.e. pseudopapilledema. It becomes more difficult when symptoms and signs are also deceptive. Symptoms in all the 14 cases were more or less same as headache, vomitting and dimunition of vision. Diplopia was present only in one case. Fundii also showed hyperaemic discs, some degree of blurring of margins, indistinct cup and venous fullness in few cases.
Fluorescein angiography has proved itself as a method of great diagnostic utility in differentiating between the two groups. In 8 cases, it demonstrated that there was no leakage of dye beyond the disc margins and the number of capillaries on the disc surface was normal. Therefore, these cases were of pseudopapill. edema, false appearance being due to myopic astigmatism, hypermetropia, venous dilatation, nuclear cataract and excessive glial tissue on disc. With the help of Fl. angio., these cases were saved from being being subjected to more complicated and risky neuroadiological investigations. These cases were differentiated from those of early papilledema as in latter cases, there was leakage of dye beyond disc margins, sometimes more marked in one sector of the disc and increased number of capillaries on the disc surface.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1], [Table - 2], [Table - 3]