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