![]() If a patient’s papilledema is secondary to intracranial mass lesion, asking about neurologic symptoms, such as weakness and loss of sensation, may provide localizing details. 1 There are some questions that should be asked to assess for factors that place a patient at more risk for such etiologies. ![]() Papilledema can be secondary to numerous etiologies including, but not limited to, intracranial mass, venous sinus thrombosis and idiopathic intracranial hypertension (IIH). ![]() In contrast, pulsatile tinnitus is a sound synchronous to the patient’s pulse due to abnormal blood flow from increased ICP. 3 It is important to differentiate this complaint from ringing in the ears (tinnitus) that can occur in conditions not related to increased ICP, such as hearing loss and Meniere’s disease. When asking about pulsatile tinnitus, describe the phenomenon as a whooshing sound with a rhythmic beat. Pertinent symptom and history questions to consider for papilledema. 1 Therefore, the clinician should ask the patient, “Do you notice a change in your vision when you bend over to pick things up or get up from laying down?” 2įig. Transient visual obscurations are typically graying or blackening of the vision that only lasts a few seconds and are more common with a change in position. The pain is often described as diffuse, may radiate down the posterior portion of the neck, and is characteristically more severe upon wakening in the morning and when laying down. 1 Headaches are an especially common symptom associated with papilledema. First, ask about common symptoms and signs of increased intracranial pressure including headaches, transient visual obscurations, pulsatile tinnitus, nausea, vomiting and diplopia. There are a number of pertinent case history questions that the clinician should ask in cases of suspected papilledema ( Figure 1). ![]() This condition can be life-threatening and thus a medical emergency, so having a plan set in mind will help the optometrist. P apilledema is a condition that presents with bilateral optic nerve head edema due to increased intracranial pressure (ICP). ![]()
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