Image Based Question-66026

A 65 year old woman presented with Headache,Confusion and blurring of vision after head injury.The fundoscopic examination of the eye shows the following picture.Which of the following is not seen in this condition ?

A. Marked venous engorgement.

B. Elevation of optic disc.

C. Cotton wool spots.

D. Prominent optic disc margins.

Correct Answer » D Explanation

Ans:D. Prominent optic disc margins.

The condition shown in the picture above represents papilledema.

The patient is suffering from raised inctracranial hypertension after head injury.

Papilledema

• It is optic disc swelling that is caused by increased intracranial pressure.

• The swelling is usually bilateral and can occur over a period of hours to weeks.

• Unilateral papilledema can suggest a disease in the eye itself, such as an optic nerve glioma.

Symptoms:

• It may be asymptomatic or present with headache in the early stages.

• It may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision may occur.

Signs of papilledema that are seen using an ophthalmoscope include:

• venous engorgement (usually the first signs)

• loss of venous pulsation

• Flame shaped and punctuate hemorrhaoges over and / or adjacent to the optic disc

• blurring of optic margins

• elevation of optic disc(mushroom/dome shaped)

• Paton’s lines or radial retinal lines cascading from the optic disc-

• Macular fan

• Cotton wool spots:They appear as fluffy white patches on the retina. They are caused by damage to nerve fibers

• When papilledema is found on fundoscopy, further evaluation with a CT or MRI of the brain and/or spine is warranted as vision loss can result if the underlying condition is not treated.