An optic disc swelling that is secondary to elevated intracranial pressure.

In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema.

Almost always presents as a bilateral problem and may develop over hours to weeks.

The underlying cause of elevated intracranial pressure is infectious, infiltrative, or inflammatory.

The optic disc swelling is the result of axoplasmic flow stasis with intra-axonal edema in the area of the optic disc.

The subarachnoid space of the brain is continuous with the optic nerve sheath, and as the cerebrospinal fluid pressure increases, the pressure is transmitted to the optic nerve, and the optic nerve sheath acts to impede axoplasmic movement.

As the pressure increases there is an accumulation of material at the lamina cribrosa, resulting in the swelling of the nerve head.

No sexual or racial predilection exists.

Can present at any age.

Most symptoms are related to the underlying elevation in intracranial pressure.

Headaches are usually worse upon awakening, and are increased with coughing or other Valsava maneuvers.

In the presence of severe intracranial pressure nausea and vomiting may occur.

May lead to loss of consciousness, pupillary dilation, and death.

Pulsatile tinnitus may be present.

Some patients may experience transient visual symptoms such a blurriness.

Visual acuity may be preserved.

Must exclude the presence of malignant hypertension.

Patient should be evaluated for neurologic problems and febrile illness.

Visual acuity, color vision, and pupillary examination findings should be normal.

Spontaneous venous pulsations that are normally present in 80% of individuals may be obliterated when the intracranial pressure rises above 200 mm water.

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