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A 51-year-old man with a medical history of hypertension presented to the ED with a 2-week headache and blurred vision, in addition to a visual defect for over 1 month. Under ophthalmic examination, visual acuity was 0.8/0.4 (1.0) and visual field test showed right 3/4 quadrantanopsia. Ocular point-of-care ultrasound was performed (figure 1).
What is the most likely diagnosis?
Papilloedema with increased intracranial pressure
C. Papilloedema with increased intracranial pressure.
Ultrasonographic optic nerve sheath diameter (ONSD) and optic disc height measurement can serve as a rapid, non-invasive method for bedside assessment of intracranial pressure (ICP). Optic disc protrusion and disc height greater than 0.6 mm are strongly associated with papilloedema.1 An estimated ONSD greater than 5 mm is consistent with ICP >20 cm H2O.2 In this case, ocular ultrasound showed protrusion of the optic disc and an enlarged ONSD of 6.25 mm (figure 2 and online supplemental video 1).
Papilloedema is defined as optic disc swelling secondary to increased ICP. Common causes of papilloedema include space-occupying lesions of the brain such as tumour, intracranial haemorrhage, central nervous system infections, idiopathic intracranial hypertension or uncontrolled hypertension.3 Papilloedema can result in vision loss and optic nerve injury if not diagnosed and treated early.
CT of the brain confirmed the diagnosis of papilloedema, with increased ICP caused by parieto-occipital parasagittal tumour (7.7×6.8×6.3 cm) (figure 3). The patient was initially treated with intravenous steroid, and craniotomy was subsequently performed a few days later to remove the brain tumour.
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Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
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