6. Evaluation of Elevated Intracranial Pressure

Differences between Elevated ICP, Papilledema, and Pseudopapilledema

It is important to note that optic disc edema doesn’t always correlate with chronic ICP elevation leading to papilledema. Pseudopapilledema is a benign elevation of the optic nerve head that has no related elevation in ICP. This condition often occurs if there is a small crowded optic nerve head, tilted optic disc, or optic nerve head drusen

Below is a table showing the differences between elevated ICP, Papilledema and Pseudopapilledema.

Acutely Elevated ICPPapilledemaPseudopapilledema
ICPAcutely highChronically highNormal
ONSD> 5 mm> 5 mmNormal
Optic Disc BulgingNormal> 0.6 mm> 0.6 mm
ExampleEarly intracranial hemorrhagePseudotumor cerebriSmall crowded optic nerve head

In the upcoming sections, we will focus on the two most common pathologies of increased ICP and/or papilledema: intracranial hemorrhage and pseudotumor cerebri (idiopathic intracranial hypertension).

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