Dr. Don Steensma 465 W. Channel Islands Blvd, Port Hueneme, CA 805/486-3585
This patient is a 55-year-old female. She presented to my office with constant headaches and a lingering fever for the last 2 weeks. She reported that her vision was distorted and colors seemed funny.
The top picture is of a normal right eye. Note that the edge of the optic nerve is very definite.
The 2nd picture is the right eye of this patient. Note that the edge of the optic nerve is blurred. Also note that their are hemorrhages adjacent to the optic nerve. The nerve is swollen. This is called papilledema.
The 3rd picture is the left eye of this patient. Note that the edge of the optic nerve is blurred, although not as much as in the right eye. Therefore this is bilateral papilledema.
Bilateral papilledema in most cases is due to an increase in intracranial pressure. The increased pressure is pushing the optic nerves away from the brain making them elevated within the eye. This increase in intracranial pressure has several possible etiologies. The most severe is a brain tumor, but also may be caused by intracranial bleeding, intracranial abscess or meningitis.
The patient was directed to the emergency room and MRI imaging of her brain was performed. Luckily, they did not find a tumor. The tentative diagnosis is pseudotumor Cerebri (idiopathic intracranial hypertension).
Pseudotumor Cerebri consists of increased intracranial pressure with papilledema and a negative MRI. It is associated with obesity, pregnancy and some medications including oral contraceptives, tetracycline, cyclosporine, and vitamin A. It is most commonly seen in young overweight females (although this patient is 55).