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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Papilledema, Swollen Left Eye, Fluid Behind Eye, Headaches, Upset Stomach, Brain Pressure A Cause Of Concern ?

My mom was just diagnosed with papilledema. The doctor said her left eye was really swelled and there was a lot of fluid behind her eye. She has been having bad headaches , and has been sick at her stomach. She has an appointment for an MRI scheduled next week. I m really worried! Is this life threatening??? The whole pressure on the brain really concerns me!
Tue, 15 May 2012
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Ophthalmologist 's  Response
Papilledema is a very specific diagnosis which refers to optic nerve edema from increased intracranial pressure... this is by definition.

So, for the moment, your mom has swollen optic nerves or optic disk edema.

Optic disk edema has multiple causes including... 1. uncontrolled high blood pressure,2. rare bilateral diabetic papillopathy and 3. strokes to the optic nerve (anterior ischemic optic neuropathy) which can rarely be bilateral, are associated with vision loss and may be associated with giant cell arteritis. Since these are all treatable easily, they must be considered. (Likewise infiltration of the optic nerve through neoplastic processes such as CNS lymphoma can cause the appearance of edema and will show up on an MRI.)

Once these possibilities have been considered, the next logical step is MRI...This is looking for CNS tumors and should be performed with contrast. If negative, lumbar puncture measuring openning pressure should be performed with removal of cerebral spinal fluid for cytology to look for signs of infection or tumor in the brain. ( This test will actually diagnose the patient with papilledema.)

The swollen nerves in this case are just a sign... the underlying reason is most important. The most common CNS tumor in middleaged women is meningioma which is benign and can be resected... everything is worse. The MRI will give your the answer.
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Papilledema, Swollen Left Eye, Fluid Behind Eye, Headaches, Upset Stomach, Brain Pressure A Cause Of Concern ?

Papilledema is a very specific diagnosis which refers to optic nerve edema from increased intracranial pressure... this is by definition. So, for the moment, your mom has swollen optic nerves or optic disk edema. Optic disk edema has multiple causes including... 1. uncontrolled high blood pressure,2. rare bilateral diabetic papillopathy and 3. strokes to the optic nerve (anterior ischemic optic neuropathy) which can rarely be bilateral, are associated with vision loss and may be associated with giant cell arteritis. Since these are all treatable easily, they must be considered. (Likewise infiltration of the optic nerve through neoplastic processes such as CNS lymphoma can cause the appearance of edema and will show up on an MRI.) Once these possibilities have been considered, the next logical step is MRI...This is looking for CNS tumors and should be performed with contrast. If negative, lumbar puncture measuring openning pressure should be performed with removal of cerebral spinal fluid for cytology to look for signs of infection or tumor in the brain. ( This test will actually diagnose the patient with papilledema.) The swollen nerves in this case are just a sign... the underlying reason is most important. The most common CNS tumor in middleaged women is meningioma which is benign and can be resected... everything is worse. The MRI will give your the answer.