Background: Studies had shown that untreated papilledema can lead to progressive irreversible visual loss and secondary optic atrophy in up to 31% of patients. The first diagnostic step in the evaluation of a patient with papilledema is a neuroimaging study, either by CT or MRI, as well as contrast-enhanced CT venography or MR venography.
Aim: To assess the diagnostic yield of neuroimaging studies among the patients presenting with papilledema.
Methodology: A hospital based prospective study was conducted in the ophthalmology department of our hospital for a period of one year between May 2015 and June 2016. A total of 120 patients with clinically diagnosed papilledema were included in our study. The patients were enquired about the past medical and surgical history, systemic illness, treatment history, personal history and family history. Complete ophthalmological examination including fundus examination was conducted on the patients. Later on a complete neurological evaluation was done on every patient including general consciousness, cranial nerve examination, motor system and sensory system evaluation. Neuro imaging was done in all patients either CT brain or MRI with MRV depending on the need and affordability of patients.
Results: The yield of neuroimaging had shown that 80% of the patients had idiopathic intracranial hypertension and 9% had cerebral venous thrombosis and the remaining 10.9% had space occupying lesions in the form of meningioma, acoustic neuroma, astrocytoma, glioma and tuberculoma. In the management aspect all the 13 patients who had space occupying lesions were referred to neurosurgery department and for other patients with IIH and CVT drugs in the form of Diamox, heparin and acitrom was given and all patients with IIH weight reduction measures were advised and during the follow-up period 2 patients underwent lumbar puncture and optic nerve sheath decompression as a mode of treatment.
Conclusion: Neuroimaging helps in early diagnosis of several intracranial lesions in patients with papilledema, which provides better prognosis and saves the life of the patient by early intervention.