Pseudopapilledema in Expert Testimony

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A case of pseudopapilledema

Minor injury to the right eye brought a 16-year-old boy to a physician where coincidentally he was found to have elevated optic disks with blurred margins. Papilledema was suspected, but the patient had no associated neurologic signs or symptoms. The noncongested, irregularly elevated optic disk (lacking a physiologic cup and dilated retinal veins), evident in the left eye, led to the diagnosis of pseudopapilledema.

Pseudopapilledema can be caused by drusen (hyaline bodies) buried in the tissue of a disk. Occasionally, optic disk drusen may result in retinal hemorrhages and subretinal neovascularization. Optic nerve swelling can also be the result of traumatic injury to the optic nerve. Recognition of pseudopapilledema is important because it precludes unnecessary neurosurgical intervention.

True papilledema is consistent with elevated intracranial pressure – a medical problem that usually warrants prompt attention. Individuals with elevated intracranial pressure may develop bilateral papilledema accompanied by intense headaches.

An ocular expert is often consulted to assess the presence or absence of papilledema, and to distinguish the presence of papilledema from pseudopapilledema.