{"id":1515,"date":"2020-04-28T03:05:55","date_gmt":"2020-04-28T03:05:55","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=1515"},"modified":"2020-07-21T23:50:17","modified_gmt":"2020-07-21T23:50:17","slug":"papilledema-2","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/04\/28\/papilledema-2\/","title":{"rendered":"Case # 19: Under Pressure"},"content":{"rendered":"
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A 27 year-old female presented to the emergency department with a two week history of headache, posterior eye pain, visual changes. She denied trauma, fever, focal neurological changes, or visual field deficits. She was seen by the optometrist earlier in the day and was sent to the ED for further evaluation.  Her neurological examination was normal. <\/p>\n

Eye exam: PERRL, EOMI, no injection\/discharge, visual acuity 20\/15 OS, 20\/20 OD, IOP L19, R19<\/p>\n

An ocular ultrasound is performed and the images below are seen. What do you see and what is your most likely diagnosis? What is your management?<\/p>\n<\/div>\n<\/div>\n<\/div>\n

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Left eye<\/h2>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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 Right eye<\/h2>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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Answer and Learning Points<\/h3>
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Answer<\/strong><\/p>\n

On both images of the right and left eye you see papilledema which is demonstrated as a bulging optic disc protruding into the posterior chamber.<\/p>\n

CT Head non-contrast was obtained which showed \" a partially empty pituitary sella which can be seen with intracranial hypertension, otherwise no acute findings.\" Ophthalmology was consulted. Their exam was unremarkable except for bilateral papilledema. An LP was performed which showed an elevated OP at 36. After large volume CSF removal the patient reported improvement in symptoms. Closing pressure was 22. The CSF studies were unremarkable. Patient was discharged with an MRI\/MRV performed as outpatient and neuro-ophthalmology follow up. MRI brain showed mild flattening of the optic nerve heads which is nonspecific but could correlate with intracranial hypertension in the right clinical setting.\u00a0<\/p>\n

Learning Points<\/strong><\/p>\n