Congestive optic disc: causes, symptoms and treatment features. Papilledema treatment

is a non-inflammatory swelling that indicates increased intracranial pressure.

This type of swelling is also called a stagnant disc. Most often it is bilateral, less often - unilateral. If there is no increased intracranial pressure, then all other causes of edema relate to the edema itself and lead to visual disturbances. Until another cause is identified, we should talk about an intracranial neoplasm in all patients with a stagnant disc. But not all patients with increased intracranial pressure develop a congestive disc.

Quite a lot of processes lead to increased intracranial pressure. Among them, the first place is occupied by intracranial tumors. Others less significant reasons increased intracranial pressure are spinal cord tumors, intracranial hypertension of unknown origin, hydrocephalus, damage to the sinuses and blood vessels of the brain, large non-tumor formations, inflammatory lesion brain, post-traumatic subdural hematoma, traumatic brain injury.

Symptoms of edema optic nerve .

Clinical manifestations of a stagnant disc are hyperemia of its tissue and swelling, caused by unclear boundaries and pattern of the disc. Typically, a congestive disc develops in both eyes, but sometimes only one eye is affected. First of all, swelling appears on the lower, then on the upper border of the disc. Then the temporal and nasal halves of the disc begin to swell. The development of a stagnant disc goes through three stages: initial, maximum and reverse development of edema.

As the edema grows, the optic disc protrudes into vitreous, spreading to the surrounding peripapillary retina. As the size of the disc increases, the blind spot expands, which is revealed by examining the visual field.

Enough long period time visual functions may remain normal, which indicates congestive optic disc and is important feature when carrying out differential diagnosis.

Another symptom of a congestive disc is a short-term sharp and sudden deterioration in vision, leading to blindness. This symptom is associated with spasm of the arteries supplying the optic nerve. Such attacks can be frequent, depending on the degree of swelling.

The caliber of the retinal veins increases with the development of the congestive disc. This arises due to the difficulty venous outflow. Hemorrhages may also occur in the area of ​​the disc and the retina that surrounds it.

Timely recognition of a congestive disc is very important, as it indicates the presence of intracranial hypertension. If signs of papilledema are detected, you should urgently contact a neurologist or neurosurgeon. To clarify the causes of intracranial hypertension, it is necessary to conduct magnetic resonance and computed tomography of the brain.

With a stagnant disc, treatment should be aimed at the underlying disease. If the disease was not detected in a timely manner and treatment was not started, atrophy of the optic nerve fibers is possible.

Date: 03/05/2016

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  • Symptoms diagnosed when edema occurs
  • How is the disease diagnosed?
  • Treatment of inflammation

Papilledema is swelling at the point where the optic nerve connects to the eye. Swelling is most often caused by intracranial pressure. This occurs due to the development of inflammatory diseases or infections that have entered the body. Moreover, in the vast majority of cases, papilledema is bilateral, that is, it is associated with both eyes at once. The disease can bother people regardless of age, but the disease is quite rare in infants, since by this age the bones of the skull do not yet have time to fully unite.

In all people suffering from papilledema, at the beginning of diagnosis it is customary to suspect an intracranial neoplasm until another cause is established. If a patient with edema experiences headaches and transient visual disturbances caused by high blood pressure inside the patient's skull, then the term “congestive optic disc” is used. But not all patients with elevated ICP have a congested disc. Patients who have been diagnosed with a stagnant disc in the past may experience sudden surges in intracranial pressure without an increase in the volume of the disc itself.

Symptoms diagnosed when edema occurs

Symptoms for which papilledema is initially diagnosed:

  1. Vomiting and nausea.
  2. Headaches that most often increase with coughing, holding your breath, waking up, or any other activity that increases intracranial pressure.
  3. Deterioration of visual abilities: dim and blurry vision, double vision or.

Papilledema occurs due to excessive pressure of the cerebrospinal fluid (cerebrospinal fluid), which is located in the cavities between the skull and the brain matter. This can lead to atrophy of the optic disc, which, if the disease is not diagnosed in time and treated, can lead to almost complete loss patient's vision.

Increased pressure can be caused by various processes that take place in the brain, spinal cord or inside the skull. And the most common causes of the disease are:

  1. Bleeding.
  2. Tumors of the spinal cord and/or brain, spine, optic nerve or skull.
  3. Abscess - accumulation purulent formations inside the skull in a small space.
  4. Hydrocephalus – accumulation in the cranial cavity cerebrospinal fluid.
  5. Traumatic brain injury.
  6. Intracranial infections – encephalitis and meningitis.

It should be noted that the most common cause of papilledema is intracranial formations. According to statistics, of all diagnosed cases of the disease, edema is to blame in 67% various kinds benign or non-benign tumors.

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How is the disease diagnosed?

The diagnosis is usually made after visual inspection eye through an ophthalmoscope. This technical device sends light to the retina through the pupil of the eye and allows the doctor to examine the fundus of the eye. In addition, special eye drops, promoting dilation of the pupils and providing a more comfortable examination of the fundus.

There are times when it is difficult to diagnose a disease. Then they resort to performing a spinal cord puncture with a study of the composition of the cerebrospinal fluid.

If signs of congestive optic disc are observed, the patient is immediately referred for consultation to a neurologist or neurosurgeon. As a rule, these actions make it possible to identify and successfully treat up to 98% of cases of the disease.

To clarify the causes of intracranial hypertension, doctors often perform magnetic resonance imaging (MRI) or computed tomography (CT) of the brain.

Diseases nervous system affect the entire body, including human vision. One of these pathologies is congestive optic disc and it occurs on both one side and both. Pathology develops due to increased pressure in the skull, which is a consequence of a tumor, head injury and other causes. The disc in this case represents the entry point into the eyeball of all nerves and blood vessels.

If the first symptoms of a disease such as papilledema occur, the patient should immediately consult a doctor. The specialist will have to conduct a diagnosis, cut off false diagnoses and find the true factor that influenced the development of the disease.

Papilledema can be caused by many factors, the most common of which are:

  • Oncological disease localized in the spinal cord or brain;
  • Hydrocephalus();
  • Head injury;
  • Hematoma caused by a blow to the head;
  • Increased intracranial pressure of unknown origin;
  • Neoplasm that is not a tumor, for example, a cyst;
  • Disruption of the relationship between the sinuses and internal jugular phenes in the brain.

The problem that appears is that optic nerve swelling occurs and retinal veins and vessels dilate in the peripapillary and papillary area. The problem can occur at any age in both women and men. The intensity of manifestations of disc congestion in the optic nerve is proportional to the force of pressure in the cranium. If there is no hypertension, then the main indicator is the appearance of formations that compress certain areas of the brain. The intensity of the manifestations of the disease will depend on the distance from the tumor to the sinuses.

Symptoms of pathology

Papilledema increases in size over time and grows into the vitreous body eyeball and retina. Due to this development pathological process The blind spot (the area insensitive to light) increases. Only an ophthalmologist can see this during an examination.

Visual acuity is usually maintained sufficiently long time, but patients often experience headaches. If such a symptom occurs, the doctor sends the patient to examine the fundus of the eyeball. Sometimes the pathology manifests itself in the form of a temporary decrease in visual acuity, up to complete blindness. This symptom occurs due to severe spasm blood vessels through which the optic nerve is nourished. The strength of the manifestation will depend on many reasons, for example, how damaged the disk is. Usually such attacks are repeated more than once and can be observed up to 3-4 times per hour.

Due to the fact that a congestive optic disc is usually accompanied by enlarged veins, the patient often experiences bleeding. Its main localization will be around the point of exit of blood vessels from the eyeball and the part of the retina that runs nearby.

If a congestive optic disc is accompanied by severe hemorrhage, this indicates severe violations blood circulation in the eyeball. Sometimes such a symptom occurs at an early stage of the development of pathology. In such a situation, the reason is hidden in a sharp increase in pressure inside the skull. This problem occurs due to the following factors:

  • Bulging of an artery wall (aneurysm);
  • Neoplasm of malignant type;
  • Toxic effect on cerebral vessels.

Papilledema has its consequences, because over time they become torn blood vessels and whitish areas appear due to which visual acuity decreases. Basically, this process occurs in the place where there is the most edematous tissue.

Signs of the disease in different periods

The congestive optic disc has several stages of development and the initial period is characterized by the following symptoms:

  • The pulse disappears from the veins (in 20% of cases);
  • The discs grow into the vitreous;
  • The part of the retina adjacent to the disc swells.

Patients' vision remains clear and discomfort does not arise. The following symptoms are typical for the next stage:

  • The blind spot grows in size;
  • The patient begins to see worse with the damaged eye;
  • Swelling increases;
  • The discs have fuzzy edges;
  • Blood circulation in the veins worsens and blood stagnation begins;
  • Whitish areas form.

The next period is called chronic, and it manifests itself with the following symptoms:

  • Shunts appear on the disc body;
  • Visual acuity periodically decreases sharply and returns back after 10-20 minutes;
  • The disc gradually bulges.

At this stage, the disease does not have symptoms such as whitish areas and hemorrhages. Most dangerous period Secondary atrophy is considered and is manifested by the following symptoms:

  • The border of the disc cannot be clearly seen, but gray vessels are noticeable on them;
  • Visual acuity drops significantly.

Papilledema should be treated when the first symptoms appear, as otherwise you can completely lose your vision.

Diagnosis of the disease

Papilledema is considered quite dangerous disease and to diagnose it, you must first exclude diseases in the skull that can cause pressure. Diagnosis is performed by an ophthalmologist, who must examine and interview the patient. If the doctor suspects the presence of a pathology, then an MRI or CT scan of the brain will be required. By placing accurate diagnosis, the specialist will be able to prescribe treatment for the patient.

The main task when performing diagnostics is to differentiate the pseudocongestive disc into which the optic nerve enters from the congestive one, because it is congenital anomaly. This deviation is associated with an irregular structure, which is often combined with refraction (beam refraction).

Course of therapy

First you need to eliminate the cause of the pathology, but you must not forget to support good nutrition nerves in the eyeball. Doctors prescribe special medications for this that improve blood circulation in the vessels, for example, Sermion or Mexidon.

If a tumor is detected in the brain, the patient will undergo surgery to remove it. After this surgical intervention The course of recovery depends on the severity of the damage caused by the tumor.

If the course of therapy was completed in a timely manner, the swelling on the optic nerve subsides within 3-4 weeks. In case of complications, the duration of treatment can range from 2-3 months to a year and after its completion the patient will have to visit a doctor for examination at least 2 times a year.

The stagnant disc, through which the optic nerve and blood vessels pass, is a very important part of the eyeball, and if it begins to swell, then treatment must be started urgently. The problem is often not independent, but only a consequence of another pathological process that has arisen in the skull, so it is important to find the culprit in time and eliminate it.

Delivery protocol medical care patients with papilledema (papiledema) (Foster-Kennedy syndrome)

ICD code - 10
N 47.1

Signs and diagnostic criteria:

In the clinic of a stagnant disc, the following stages are distinguished:
1. Initial- slight marginal edema of the disc appears - blurred disc boundaries, slight protrusion of the disc into the vitreous body, the temporal edge of the disc remains swollen for a long time, radial striations on the borders of the disc, veins are slightly dilated
2. Expressive stage - further enlargement of the disc, its prominence and greater blurring of its borders, veins are dilated and tortuous, vessels are closed in places by edematous tissue, small hemorrhages on the borders of the disc, white foci of extravasation on the disc.
3. Developed stage (advanced) - the symptoms of edema increase, prominence reaches 2 - 2.3 mm (6-7 diopters), an increase in the diameter of the disc, pronounced hyperemia of the disc, vessels on the disc are poorly visible, hemorrhages on the disc. The swelling may spread to the area of ​​the macula (may be a clinical picture of albuminuric retinitis).
4. Preterminal- edema with transition to atrophy, a grayish color of the disc appears against the background of a decrease in edema, the caliber of the veins becomes smaller, hemorrhages and white lesions resolve, the size of the disc decreases, it becomes dirty white with unclear boundaries.
5. Terminal- stage of secondary optic nerve atrophy, the disc is pale gray in color with unclear boundaries, the arteries are narrowed, there are fewer of them on the disc, the veins reach normal caliber, further progressing blanching of the disc and narrowing of the retinal vessels.

The process is two-way. There may be episodes of rapid vision loss, headache, nausea. With the development of optic nerve atrophy, visual acuity deteriorates and narrowing appears peripheral field vision, especially from the lower nasal side.

Foster-Kennedy syndrome- primary atrophy of the optic nerve in one eye (from the side of the tumor location - compression of the optic nerve) and congestive disc in the second eye. A sharp decline in vision to the point of blindness in the eye with atrophy of the optic nerve.

Levels of medical care:
Third level - ophthalmology hospital

Examinations:
1. Visometry
2. Perimetry
3. Ophthalmoscopy
4. Color vision examination
5. Computed tomography and NMR scanning of the orbit and brain.
6. Echography of the orbit
7. Fluorescein angiography

Mandatory laboratory tests:
1. General analysis blood
2. General urine test
3. Blood on RW
4. Blood sugar

Consultations with specialists according to indications:
1. Therapist
2. Neuropathologist
3. Neurosurgeon

Characteristic therapeutic measures:

Treatment is aimed at eliminating the underlying disease (tumor removal, treatment of meningitis, arachnoiditis, cerebral hemorrhage).

During the examination and before surgical intervention dehydration therapy is prescribed:
i/v 40% glucose 20 ml daily, 10% calcium chloride solution, i/m 25% magnesium sulfate solution 10 ml daily No. 20, 1% furosemide 2 ml once every 2 days, orally diacarb, furosemide, clopamide , triampur, ticlid, glyceryl. 0.4% dexamethasone 0.5-1.0 ml is administered retrobulbarly.

Final expected result- possible preservation of vision

Duration of treatment- 10 days

Treatment quality criteria:
Elimination of the underlying disease, possible preservation of vision

Possible side effects and complications:
Atrophy of the optic nerve of the second eye.

Dietary requirements and restrictions:
According to consultation.

Requirements for the regime of work, rest and rehabilitation:
Disability is determined by the underlying disease and the neurosurgical operation performed (several months). Clinical examination.

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Performs the function of transmitting signals from the eye to the brain. Edema, the symptoms of which are caused by increased pressure inside the skull, is diagnosed in humans of various ages and gender. Puffiness is expressed in the form of a tumor of the optic nerve, provoked a large number cerebrospinal fluid (CSF). It accumulates between the bones of the skull and the brain matter. In most cases, this is a bilateral phenomenon. Ophthalmological pathology in newborns is rarely diagnosed, since the cranial bones in infancy are not yet fully connected.

Symptoms of swelling of the eye

On initial stage Symptoms of swelling or swelling of the optic nerve include:

  • after waking up or when a person holds his breath or coughs, severe headaches are felt;
  • vomiting and frequent urges occur;
  • double vision and flickering appear in the eyes, visual acuity deteriorates, the person begins to see a blurry picture;
  • possible loss of venous pulsation;
  • The optic disc may become elevated.

With swelling of the optic nerve, the blind spot increases in diameter rapidly. As a result of ignoring the disease, atrophy of the optic disc may occur. The phenomenon, in turn, leads to complete loss of vision by the patient. Pressure increases due to various processes occurring in the brain and spinal cord, inside the skull.

Clinical picture of edema

On entry level As the disease progresses, vision does not deteriorate, but periodically becomes blurred, there are no foci of inflammation, the eye vessels are in acceptable tension. After the onset of edema, color perception may be impaired, venous hemorrhages appear on the disc itself, and the fundus of the eye swells. Due to lack of treatment, vision begins to decline.

What causes swelling?

Papilledema results from increased intracranial pressure, as already mentioned in the article. This phenomenon carries the threat of developing brain cancer, inflammation of the central nervous system, and intracranial hypertension.

The reasons that increase it include the following phenomena:

  • tumors of the optic nerve, skull, spine, brain, spinal cord;
  • hemorrhages;
  • a large amount of cerebrospinal fluid in the skull (hydrocephalus);
  • abscess;
  • craniocerebral injuries;
  • encephalitis and meningitis (intracranial infections);
  • respiratory failure;
  • low blood pressure;
  • excess vitamin A.

How to identify pathology?

Ophthalmologists examine using an ophthalmoscope visual apparatus person. Before the actual examination, special drops are used that enlarge the pupil. The instrument makes it possible to transmit light to the retina itself, thereby allowing the doctor to examine the condition of the fundus of the eye. Additionally, an examination by a neurologist is prescribed.

When it is not possible to diagnose the disease in this way, the doctor performs a puncture of the brain in the back, examining the composition of the fluid located there.

To more accurately determine the causes of hypertension, specialists often perform CT scans ( computed tomography brain) or MRI (magnetic resonance imaging).

How to cure visual pathology?

Papilledema, the symptoms of which are listed above, is treated depending on the cause that provoked it. Therefore, in order to recover and restore vision, it is necessary to get rid of the underlying disease. Thus, increased intracranial pressure is reduced with the help of drugs that reduce the production of cerebrospinal fluid.

To treat the edema itself, diuretics are used to rid the body of excess accumulated fluid. If a person suffers from excess weight, I also suggest he take a course special program losing weight. When swelling has formed due to inflammation, corticosteroids (quickly relieve symptoms of pathology), antihistamines and antibacterials are also prescribed medicines. In some cases, it is advisable to undergo surgery.

Are there certain preventive measures?

A miracle drug that would prevent the appearance of edema has not yet been invented. But a person can protect himself from pathology without exposing his head to injury, as well as by promptly healing everything. inflammatory diseases and infections. Always follow the therapy prescribed by your doctor to the end. Do not stop treatment at the first relief of symptoms. Don't skip annual checkups with your ophthalmologist. Additionally, visit the ophthalmologist's office if you notice strange changes in the eye apparatus or feel unwell.

Every person should understand that swelling of the optic nerve and lack of treatment for the pathology leads to irreversible consequences, including complete loss of vision, which becomes a consequence of atrophy. That is why it is so important to consult a doctor at the first symptoms of the disease and follow all recommendations. With timely diagnosis of pathology and effective treatment You can return your vision to normal without further consequences.

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