Congestive papilla
| Classification according to ICD-10 | |
|---|---|
| H47.1 | Congestive papilla, unspecified |
| ICD-10 online (WHO version 2019) | |
As papilledema one is papilledema referred entering due to compromised blood outflow. This edematous swelling of the optic nerve papilla ( papilla nervi optici ) at the exit point of the optic nerve from the eyeball is mostly due to an increase in intracranial pressure .
A congestive papilla usually occurs on both sides and, if it persists for a long time, can be associated with damage to optic nerve fibers. In a one-sided space-occupying process in the anterior cranial fossa, compression of the optic nerve on the same side can lead to optic atrophy , so that a congestive papilla can only be observed on the opposite side (see Foster Kennedy syndrome ).
causes
The round discus nervi optici is not only the point of passage for the fibers of the optic nerve through the dermis of the eyeball, but also for the central retinal vessels ( vasa centralia retinae ), which run as the central retinal artery and central retinal vein within the optic nerve head. Therefore, if the blood flow is obstructed, the optic nerve papilla, which is normally slightly indented, can swell and bulge. In addition to occlusions of the draining blood passages ( central vein thrombosis , sinus thrombosis ), various diseases that lead to increased pressure inside the brain skull (intracranial pressure) can be the reason.
Most commonly, papillae occurs in connection with a space-occupying process in the cranial cavity that causes an increase in pressure. For this to come out of a brain tumor or intracranial metastases and brain haemorrhages and meningeal hematoma , inflammation or infection of the brain and meninges, otogenic abscesses , aneurysms of cerebral vessels and other diseases or abnormalities considered. Increased intracranial pressure can also occur as a crisis with increased blood pressure or due to pent up brain water . Since the formation of the papillary edema is also time-dependent, a pronounced congestive papilla is more likely to be found in chronically increased intracranial pressure , not as an expression of acute increased intracranial pressure.
Diagnosis
The method of choice for the diagnosis of a congestive papilla is the reflection of the fundus ( ophthalmoscopy ), in which the papilla is assessed for blurring, reddening and bulging, among other things. In individual cases, sonography of the eyeball can also be helpful. The detection of a congestive papilla - even without accompanying headache or visual disturbances - is to be understood as an urgent request to immediately look for underlying causes inside the skull and especially in the brain. For this purpose, a neurological examination including imaging of the inside of the skull using computed tomography or magnetic resonance imaging is advisable. A lumbar puncture to remove cerebral fluid (liquor) in the presence of a congestive papilla should, however, only be carried out after an intracranial mass has been excluded and then also include a CSF pressure measurement to exclude a pseudotumor cerebri . If there is a mass, however, the lumbar puncture should not be performed, as it could be associated with the risk of life-threatening entrapment of the brain stem .
literature
- Rudolf Sachsenweger: Neuroophthalmology . Thieme Verlag, Stuttgart; 3rd edition, (January 1983) ISBN 978-3-13-531003-9
- Barbara Bates: A guide to physical examination and history taking. 5th edition. JB Lippincott, Philadelphia PA et al. 1991, ISBN 0-397-54781-1 .
Remarks
- ↑ Leonard S. Lilly (ed.): Pathophysiology of Heart Disease. A Collaborative Project of Medical Students and Faculty. 5th edition. Lippincott Williams & Wilkins, Philadelphia PA 2011, ISBN 978-1-60547-723-7 , p. 317.
