Papilledema

Last revised by Francis Deng on 6 May 2022

Papilledema refers to swelling of the optic disc related to increased intracranial pressure.

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Although papilledema literally means swelling of the optic disc (nerve head/papilla), it is distinguished in common ophthalmological parlance from optic disc edema 8-10. Papilledema refers to optic disc edema due to increased intracranial pressure, while optic disc edema is the more general term that can be from any etiology.

The MRI appearance relates to the dural anatomy of the optic nerve, which is continuous with the subarachnoid space, thereby allowing increased intracranial pressure (ICP) to be transmitted to the optic disc. In most cases, the papilledema is bilateral. However, it can be unilateral in Foster Kennedy syndrome and its pseudovariants.

Note however that with the advent of motion correction (e.g. BLADE) sequences, CSF in the dural sheath over the optic nerve is much more frequently seen, and caution should be shown when reporting this. Flattening or bulging of the optic nerve head is probably a more specific sign.

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The differential includes optic disc edema from other causes (such as optic neuropathy, hypertensive retinopathy, papillitis, and orbital tumors) and pseudoedema (pseodupapilledema) from optic disc drusen 2,3.

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