Stages of Papilledema Kathleen B. Digre MD James J Corbett MD
Stages of Papilledema
Kathleen B. Digre MD James J Corbett MD
Frisn Scale of Papilledema Grade 0 Papilledema
Look at NFL, cup, vessels, swelling
Minimal swelling of the nasal margin
NFL clear No vessel
obscuration Cup if present not
obscured
Frisn Scale Grade 1 Papilledema
230 degree C-shaped swelling of the nasal, superior and inferior borders
Temporal margin is normal with sharp disc margin
Cup if present is maintained
Frisn Scale Grade 2 Papilledema
Elevation of the temporal margin
360 disc swelling No major vessel
obscuration
Frisn Scale Grade 3 Papilledema
Elevation of the entire disc
360 degrees swelling
Partial Vessel obscuration at disc margin
Cup may be obscured
Frisn Scale Grade 4 Papilledema
NFL opaque/360 swelling
Vessels largely, but not completely, obscured on disc surface and lost at the margins
Frisn Scale Grade 5 Papilledema
NFL opaque/360 swelling
Vessels obscured on
disc surface
Non-essential, but common incidental findings in papilledema
Splinter, sub-retinal, pre-retinal and intraretinal hemorrhages
Retinal and choroidal folds Patons lines Nerve fiber layer infarcts Venous tortuosity Partial macular star AION, BRAO, CRAO and vein occlusion Retino-choroidal collateral veins
Hemorrhages
Incidental Findings: PAPILLEDEMA--Folds
Patons Lines Choroidal folds
Nerve Fiber layer infarcts and partial macular star
ATROPHIC PAPILLEDEMA
Gliosis Pallor High water marks
UNILATERAL PAPILLEDEMA
The non-swollen nerve is protected from high ICP by a tight optic canal
RESOLVING PAPILLEDEMA
OD OS
Stages of PapilledemaFrisn Scale of Papilledema Grade 0 PapilledemaLook at NFL, cup, vessels, swellingFrisn Scale Grade 1 PapilledemaFrisn Scale Grade 2 PapilledemaFrisn Scale Grade 3 PapilledemaFrisn Scale Grade 4 PapilledemaFrisn Scale Grade 5 PapilledemaNon-essential, but common incidental findings in papilledemaSlide Number 9Incidental Findings: PAPILLEDEMA--FoldsSlide Number 11ATROPHIC PAPILLEDEMAUNILATERAL PAPILLEDEMASlide Number 14