The role of clinical signs in the diagnosis of papilledema: development of an algorithm
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ORIGINAL ARTICLE
The role of clinical signs in the diagnosis of papilledema: development of an algorithm Sevim Türay 1
&
Nimet Kabakuş 1 & Fatma Hancı 1 & Fatih Ulaş 2 & Mustafa Dilek 3 & Büşra Cihan 3
Received: 17 June 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of this study was not only to emphasize the role of clinical signs as well as ophthalmologic evaluation for accurate and differential diagnosis of papilledema (PE), but also to present an instructive algorithm that would help to eliminate unnecessary examinations and treatments. Method The files of 43 patients (ages 0–18) diagnosed with PE were retrospectively reviewed. The study included 25 patients from our pediatric neurology outpatient clinic, who were thought to have PE, and 18 patients, who were referred from the external centers to our hospital with a pre-diagnosis of PE. Results Of the 43 patients, 28 had PE, 8 had pseudopapilledema (PPE), and 7 had optic nerve pathologies (ONP). For patients who applied directly to our pediatric neurology unit, a margin of error of 8% was detected based on only a simple ophthalmologic examination and an evaluation of clinical findings. For the patients who were forwarded to our pediatric neurology unit from the external centers without examining any clinical findings and with no details, the margin of error was 72%. Conclusion For patients with suspected PE, advanced ophthalmologic opinion is a necessary requirement before invasive radiological examinations are used. When the ophthalmologic evaluation is properly elaborated, the distinction can be made more clearly by using noninvasive methods. In order to determine the gold standard in terms of the methods used in the evaluation of patients who are not clinically diagnosed, new prospective studies with more patients should be planned. Keywords Papilledema . Pseudopapilledema . Pseudotumor cerebri . Optic nerve pathologies
Introduction Although papilledema (PE) is simply defined as the swelling of the optic disc due to increased intracranial pressure, the correct diagnosis in childhood is complicated and stressful for both the clinician and the patient and his/her family. PE may occur as a result of idiopathic (pseudotumor cerebri-PTC) and secondary (space occupying tumor, structural anomalies, infection, sinus vein thrombosis, medication, etc.) reasons [1], and may present
* Sevim Türay [email protected] 1
Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
2
Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
3
Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
a life-threatening picture [2]. Even though PE is asymptomatic in the early period, it disrupts venous flow over time. Besides, it may lead to secondary optic atrophy and vision loss after optic nerve ischemia and telangiectasia formation [3, 4]. On the other hand, pseudopapilledema (PPE) cases
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