Case 14- Papilledema (Bilateral)
Author: Dr Gokul Sagar Bailur Reviewer: Dr Salman Naeem
A lady in her 30s presented to the emergency department with a two-week history of ongoing headache and blurred vision. She has a BMI of 32 but no other co-morbidities.
Her vital signs were within normal limits. Physical examination revealed no focal neurological deficits. Fundoscopy was attempted but was inconclusive due to undiluted pupil.
Considering the patient's clinical features, risk factor, and inconclusive fundoscopy, Ocular point-of-care ultrasound (POCUS) was performed as an extension of standard clinical assessment:
Clip 1 : Left eye showing bulged optic disc ; Clip 2 : Right eye showing bulged optic disc highly suggestive of papilledema
Case resolution:
Bloods and CT head was unremarkable. The patient was admitted to the acute medical ward for further assessment.
Lumber puncture was performed with the opening pressure of 35 cmH2O. Following CSF drainage of appropiate amount, the patient's symptoms improved significantly. A final diagnosis of idiopathic intracranial hypertension was made, and the patient was discharged the next day with appropriate medications and follow-up.
Take-Home Message:
Performing fundoscopy with undated pupils is challenging even in the hands of the most experienced and competent physicians. Ocular POCUS, mostly as a rule-in and as an extension of standard clinical assessment, could expedite patient diagnosis and care
