Papilledema and Idiopathic Intracranial Hypertension

Deborah I. Friedman, MD, MPH, FAAN Neuro-ophthalmology p. 857-876 August 2014, Vol.20, No.4 doi: 10.1212/01.CON.0000453314.75261.66
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Purpose of Review:: Papilledema is one of the most concerning physical examination findings in neurology: it has a broad differential diagnosis of intracranial (and occasionally spinal) pathology associated with increased intracranial pressure. Papilledema impairs axoplasmic flow within the optic nerves and compresses the optic nerves externally; it may lead to profound visual loss. Thus, detection of papilledema and assessment of visual function are essential to patient management. This article reviews the treatment of papilledema-related visual loss in pseudotumor cerebri syndrome, one of the most common causes of papilledema encountered by neurologists.

Recent Findings:: Results from the Idiopathic Intracranial Hypertension Trial (IIHTT), the first randomized, double-masked, placebo-controlled trial for the treatment of patients with mild visual loss from idiopathic intracranial hypertension, were published in April 2014. The IIHTT provides the first evidence-based treatment recommendations, showing the benefit of acetazolamide and weight loss for improving visual status in patients with mild visual field loss from idiopathic intracranial hypertension.

Summary:: A detailed ophthalmic examination, including perimetry, is critical to the evaluation, treatment, and assessment of treatment response in patients with papilledema.

Address correspondence to Dr Deborah I. Friedman, Departments of Neurology and Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 9036, Dallas, TX 75390,

Relationship Disclosure: Dr Friedman’s institution receives grants from electroCore Medical LLC, Merck & Co, Inc, and the National Eye Institute, and her institution has received compensation for her speaking activities from Allergan, Inc. Dr Friedman has served as an expert witness regarding pseudotumor cerebri syndrome for various legal firms, on the board of the American Headache Society, on the editorial board of Neurology Reviews, and as a consultant for Zogenix, Inc. She has received personal compensation for the development of educational programs from the AAN and for manuscript preparation from MedLink Neurology.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Friedman discusses the unlabeled use of acetazolamide for the treatment of papilledema in idiopathic intracranial hypertension.

© 2014 American Academy of Neurology