Aetiology

Papilloedema results from raised intracranial pressure in which the subarachnoid space surrounding the optic nerve is patent, i.e. papilloedema is not a necessary consequence of raised intracranial pressure.

The most common situations are:

• intracranial space-occupying lesions - tumours, especially of the posterior fossa; cerebral abscesses; subdural haematoma
• any condition causing hydrocephalus in an adult, e.g. subarachnoid haemorrhage, meningitis, head injury
• venous obstruction - especially due to venous sinus thrombosis
• benign intracranial hypertension - most likely in patients with visual complaints but otherwise normal
• malignant hypertension - bilateral with other signs of hypertensive neuropathy
• central retinal venous occlusion, ischaemic optic neuropathy, optic neuritis - unilateral with sudden loss of vision
• chronic carbon dioxide retention

Other rare causes include:

• metabolic:
  • hypoparathyroidism
  • diabetic ketoacidosis
  • chronic carbon dioxide retention
  • obesity
• haematological - anaemia, leukaemia
• toxic - tetracycline, lead, oral progestational agents, corticosteroid withdrawal
• spinal cord tumours, perhaps due to high CSF protein levels

Reference

1. Rigi M, Almarzouqi SJ, Morgan ML, et al. Papilledema: epidemiology, etiology, and clinical management. Eye Brain. 2015 Aug 17;7:47-57.