Stauungspapille, Pseudotumor cerebri und idiopathische intrakranielle Hypertension – Was gibt es Neues?

Zusammenfassung

Die Differenzierung von Stauungspapille, Papillenschwellung und Pseudopapillenschwellung (z. B. kleine, hyperope oder schräge Papillen) bereitet dem Ophthalmologen häufig Schwierigkeiten. Dies führt nicht selten zu Fehldiagnosen, Überdiagnostik und Verzögerungen in der Behandlung. Diese Übersichtsarbeit fasst die neue Literatur zur Stauungspapille im Rahmen des Pseudotumor-cerebri-Syndroms zusammen und vertieft das Verständnis zur Diagnostik und Therapie bei idiopathischer intrakranieller Hypertension (IIH). Dabei wird deutlich, dass sich viele neue Erkenntnisse ergeben haben, wie z. B. der neue Phänotyp des IIH-typischen Kopfschmerzes, der Einsatz der OCT bei der Verlaufsbeurteilung der Stauungspapille und erste Ib-Evidenzstudien zur Therapie mit Acetazolamid. Die Optikusscheidenmeningozele ist eine seltene Differenzialdiagnose in diesem Kontext.

Abstract

Several conditions share a cardinal feature on funduscopic examination: bilateral blurred optic disc margins. Pseudopapilledema (e.g., small hyperopic discs, tilted discs) and optic disc swelling can all be mistaken for papilloedema, which is caused by raised intracranial pressure. Diagnostic errors in papilloedema can lead to a delay of necessary treatments. This contribution will discuss the current progress in diagnosis and treatment of papilloedema and idiopathic intracranial hypertension. This clearly demonstrates that the new literature on pseudotumor cerebri syndrome and idiopathic intracranial hypertension has changed our understanding of its clinical picture during recent years and provides a key prerequisite for evidence-based recommendations on the management of affected patients. The optic nerve sheath meningocele as a rare differential diagnosis in that context will be discussed.

Schlüsselwörter

Stauungspapille - Pseudotumor cerebri - idiopathische intrakranielle Hypertension - Optikusscheidenmeningozele - Acetazolamid - Optikusscheide

Key words

papilloedema - pseudotumor cerebri - idiopathic intracranial hypertension - optic nerve sheath meningocele - optic nerve sheath fenestration - acetazolamide

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