Edema of the optic disc

Protocol for the provision of medical care to patients with edema of the optic nerve disk (papilledema) (Foster-Kennedy Syndrome)

Code of the ICD - 10
H 47.1

Signs and diagnostic criteria:

Stagnant optic disc - a consequence of increased intracranial pressure.

Etiology
various brain diseases - tumors, abscesses, arachnoiditis, hemorrhages, meningitis, atherosclerosis, parasitic cysts, thrombosis of the sagittal sinus.

In the clinic of the stagnant disc, the following stages are distinguished:
1. Initial - there is a slight edema of the disc -blurred disc borders, a slight protrusion of the disc in the vitreous, the temporal edge of the disc remains edematous for a long time, radial striation at the disc margins, veins slightly widened
2. Expressive stage - further increase in the disk, itsthe prominence and great blurring of its borders, the veins are broadened and crimped, the vessels are sometimes closed with swollen tissue, small hemorrhages on the borders of the disk, white foci of transudation on the disk.
3. Developed stage (far-reaching) - the phenomenon of edemaincrease, prominence reaches 2 - 2.3 mm (6-7 dpt), an increase in the diameter of the disc, pronounced disk hyperemia, vessels on the disc are poorly visible, hemorrhages on the disk. Edema can spread to the site of the macula (there may be a clinic of albuminuric retinitis).
4. Preterminal - edema with the transition to atrophy, appearsgreyish disc color against the background of reduced edema, the caliber of veins becomes smaller, bleeding and white spots disappear, the size of the disc decreases, it becomes dirty-white with indistinct boundaries.
5. Terminal - stage of secondary atrophy of the optic nerve,a disc of pale gray with fuzzy boundaries, arteries narrowed, they become smaller on the disk, the veins reach a normal caliber, further progressive blanching of the disc and narrowing of the retinal vessels.

The process is two-sided. There may be episodes of fast-flowing vision loss, headache, nausea. With the development of optic atrophy, deterioration of visual acuity is observed, narrowing of the peripheral field of vision appears, especially from the lower nasal side.

Foster-Kennedy Syndrome - primary atrophy of the optic nerve on oneeye (from the location of the tumor - compression of the optic nerve) and a stagnant disc on the second eye. Sharp drop in vision to blindness in the eye with optic nerve atrophy.

Levels of medical care:

Third level - hospital of ophthalmological profile

Surveys:

1. Visometry
2. Perimetry
3. Ophthalmoscopy
4. Research of color vision
5. Computer tomography and NMR scanning of the orbit and brain.
6. Echography of the orbit
7. Fluorescence angiography

Mandatory laboratory tests:

1. The general analysis of a blood
2. General analysis of urine
3. Blood on RW
4. Blood sugar

Consultations of specialists on indications:
1. Therapist
2. Neuropathologist
3. Neurosurgeon

Characteristics of treatment activities:

Treatment is aimed at eliminating the underlying disease (removal of the tumor, treatment of meningitis, arachnoiditis, cerebral hemorrhage).

At the examination and before surgery, dehydration therapy is prescribed:
iv 40% glucose 20 ml daily, 10% solutioncalcium chloride, IM 25% solution of magnesium sulfate 10 ml daily No. 20, 1% furosemide 2 ml every 2 days, orally diacarb, furosemide, clopamide, triampur, ticlid, glyceryl. Retrobulbarno injected with 0.4% dexamethasone 0.5-1.0 ml.

The final expected result - Preservation of vision is possible

Term of treatment - 10 days

Criteria of quality of treatment:
Elimination of the underlying disease, vision preservation possible

Possible side effects and complications:</ strong>
Atrophy of the optic nerve of the second eye.

Requirements for dietary appointments and restrictions:</ strong>
According to the consultation.

Requirements for working, rest and rehabilitation:
Incapacity for work is determined by the underlying disease and performed by a neurosurgical operation (several months). Clinical examination.