Introduction

Papilledema, or optic nerve edema secondary to increased intracranial pressure, is a well-established sign of increased intracranial pressure. Determining whether or not the intracranial pressure is actually high is important, especially in acute cases such as head trauma and intracranial bleeding. It’s difficult to determine intracranial pressure; even invasive measurements such as lumbar punctures or epidural probes are not always accurate.

Ophthalmologists are often asked to consult on these types of problems, whether it’s an acute-onset headache, suspected intracranial abnormality such as pituitary apoplexy, ruptured aneurysm, closed head trauma, patency of a previous neurosurgical shunt in the setting of an acute headache, etc. The workup typically involves some combination of the following: