Department of Ophthalmology, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan 48109, USA.
J Neuroophthalmol. 2011 Jun;31(2):175-86. doi: 10.1097/WNO.0b013e31821a8b0b.
Papilledema has long been recognized as a valuable sign of increased intracranial pressure (ICP). But because papilledema is based on interruption of the energy-dependent process of axoplasmic flow, it appears late after a rise in ICP. Papilledema is usually present in chronically high ICP but sometimes asymmetrically in the 2 eyes and rarely in 1 eye only. Distinguishing it from other optic neuropathies that produce elevated optic discs is challenging, especially in the chronic phase, when visual function may be impaired. Papilledema is often an unrecognized cause of optic disc edema in inflammatory and compressive meningeal disorders that interfere with cerebrospinal fluid (CSF) passage through the arachnoid granulations. Its detection is particularly critical in patients with noncompliant ventricles or extraventricular blockage of cerebrospinal flow because imaging may fail to disclose conventional signs of high ICP. Therefore, patients with indwelling CSF shunts, tuberous sclerosis, chronic granulomatous meningitis, or meningiomatosis should be periodically examined for papilledema so that timely ICP-lowering measures can be instituted to preserve vision.
视盘水肿长期以来一直被认为是颅内压（ICP）升高的一个有价值的征象。但由于视盘水肿是基于轴浆流的能量依赖过程中断，因此在 ICP 升高后出现较晚。视盘水肿通常在慢性高 ICP 时存在，但在两眼之间有时不对称，很少仅在一只眼中出现。将其与其他产生高视盘的视神经病变区分开来具有挑战性，尤其是在慢性阶段，此时视力可能受损。视盘水肿通常是炎症和压迫性脑膜疾病导致的视盘水肿的未被识别的原因，这些疾病会干扰脑脊液（CSF）通过蛛网膜颗粒的流动。在脑室顺应性差或脑脊液流动的脑室外阻塞的患者中，其检测尤其关键，因为影像学可能无法揭示 ICP 升高的常规征象。因此，应定期检查留置 CSF 分流管、结节性硬化症、慢性肉芽肿性脑膜炎或脑膜瘤患者的视盘水肿，以便及时采取降低 ICP 的措施来保护视力。
