Diagnostic dilemma of papilledema and pseudopapilledema

• Published in: International ophthalmology 2024-06, Vol.44 (1), p.272, Article 272
• Main Authors: El-Gendy, Raghda Shawky, El-Hamid, Ahmad Shehata Abd, Galhom, Ayman El-Sayed Ali, Hassan, Nihal Adel, Ghoneim, Ehab Mahmoud
• Format: Article
• Language: English
• Subjects: Angiography; Diagnosis, Differential; Edema; Eye Diseases, Hereditary - diagnosis; Fluorescein Angiography - methods; Fundus Oculi; Humans; Intervertebral discs; Intracranial pressure; Ischemia; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Medicine; Medicine & Public Health; Ophthalmology; Optic Disk - diagnostic imaging; Optic Disk - pathology; Optic Disk Drusen - complications; Optic Disk Drusen - diagnosis; Optic Disk Drusen - physiopathology; Optic nerve; Optic Nerve Diseases - diagnosis; Optics; Papilledema - diagnosis; Review; Swelling; Tomography; Tomography, Optical Coherence - methods
• ISSN: 1573-2630; 0165-5701; 1573-2630
• DOI: 10.1007/s10792-024-03215-5

Background Papilledema is the optic disc swelling caused by increased intracranial pressure (ICP) that can damage the optic nerve and cause subsequent vision loss. Pseudopapilledema refers to optic disc elevation without peripapillary fluid that can arise from several optic disc disorders, with optic disc drusen (ODD) being the most frequent cause. Occasionally, pseudopapilledema patients are mistakenly diagnosed as papilledema, leading to the possibility of unneeded procedures. We aim to thoroughly examine the most current evidence on papilledema and pseudopapilledema causes and several methods for distinguishing between both conditions. Methods An extensive literature search was conducted on electronic databases including PubMed and google scholar using keywords that were relevant to the assessed pathologies. Data were collected and then summarized in comprehensive form. Results Various techniques are employed to distinguish between papilledema and pseudopapilledema. These techniques include Fundus fluorescein angiography, optical coherence tomography, ultrasonography, and magnetic resonance imaging. Lumbar puncture and other invasive procedures may be needed if results are suspicious. Conclusion Papilledema is a sight-threatening condition that may lead to visual affection. Many disc conditions may mimic papilledema. Accordingly, differentiation between papilledema and pseudopailledema is crucial and can be conducted through many modalities.