We describe a 5 year old child who was found to have bilateral optic disc swelling in association with superficial optic disc haemorrhages, investigated and diagnosed with idiopathic intracranial hypertension. His optic disc appearances remained unchanged despite treatment. A B-mode ultrasound B scan and auto-fluorescence study confirmed the presence of optic disc drusen. Fundus fluorescein angiography excluded optic disc oedema.
As illustrated by this case the clinical differentiation of pseudopapilloedema from true papilloedema can be challenging. Characteristic retinal nerve fiber layer (NFL) haemorrhages do occur in association with ODD and should not preclude the diagnosis. We highlight the combined use of B-mode ultrasound and fluorescein angiography for the accurate diagnosis and differentiation of optic disc drusen and true optic disc swelling. These readily available investigations may render more invasive ones unnecessary.
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