Role of ultrasonographic optic nerve sheath diameter in the diagnosis and follow-up of papilledema and its correlation with Frisén's severity grading

Purpose: The aim of this study was to compare the ultrasonographic optic nerve sheath diameter (ONSD) in different grades of papilledema and in controls and to evaluate ONSD in atrophic papilledema/optic atrophy when raised ICP was suspected. Methods: Prospective cross-sectional case–control study. Following an ocular examination, papilledema was graded clinically using modified Frisén's grading. An ultrasonographic cross section of the retrobulbar optic nerve was obtained with a posterior transverse scan. Independent t-test and analysis of variance were the statistical tools used in the study. Results: The study included 55 cases and 55 age- and gender-matched controls; mean (± standard deviation) age was 37.17 (±11.25) years and male: female ratio was 49:61. There was a statistically significant difference in the mean ultrasonographic ONSD between cases [4.89 (±0.65) mm] and controls [3.12 (±0.22) mm] (P < 0.001). There was a significant difference in the mean ONSD across Frisén's grades of papilledema (P < 0.001). The mean ONSD in atrophic papilledema was 6.2 (±0.75) mm. Conclusion: In the presence of symptoms, ultrasonographic ONSD >4 mm is diagnostic of papilledema. Ultrasonographic ONSD correlates well with the severity of papilledema and can be used to follow-up patients with chronically elevated ICP. It is useful in detecting raised ICP in the presence of optic atrophy and to distinguish true papilledema from pseudopapilledema.

Etiological Profile Of Patients With Papilledema

Papilledema is a finding which harbors multiple etiologies. Hence a better understanding of this condition will assist in the early management and prevention of complication from papilledema itself as well as condition causing it. OBJECTIVE: Aim of This study was to ascertain the etiological proportion of papilledema cases in IPD setting. METHOD AND MATERIALS: 100 patient with initially confirmed papilledema as per modified frisen papilledema scale were retrospectively studied at Gandhi Medical College and Hamidia Hospital from May 2014 to December 2014. Patients undervent a detailed clinical evaluation followed by laboratory investigations and neuroimaging studies. Patient having optic disc edema other than raised ICT and patient whith head injury were excluded. RESULTS: Present study showed female preponderance with F:M 1.2:1. Incidence was common in age groups of 2nd and 4th decade. Meningitis was the most commom etiology associated with papilledema observed in 38%, followed by intracranial hemorrhage(23%), cereal venous thrombosis (20%),intracranial space occupying lesion (10%),idiopathic (9%).CONCLUSION: Meningitis was the commonest etiology associated with papilledema.