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Absence of spontaneous venous pulsations in children with pseudopapilloedema
  1. Noha S Ekdawi,
  2. Michael C Brodsky
  1. Departments of Ophthalmology and Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
  1. Correspondence to Professor Michael C Brodsky, Mayo Clinic, Departments of Ophthalmology and Neurology, 200 First Street Southwest, Rochester, MN 55905, USA; brodsky.michael{at}mayo.edu

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The distinction between papilloedema and pseudopapilloedema is critical in the medical management of children with elevated optic discs. By convention, the term papilloedema has been assigned to optic disc swelling caused by elevated intracranial pressure. Early ophthalmoscopic signs of papilloedema include optic disc elevation, venous distension, obscuration of the major retinal vessels (particularly at the disc margin), hyperaemia of the disc, opacification of the peripapillary nerve fibre layer and absent retinal venous pulsations. Later signs include flame-shaped haemorrhages, peripapillary subretinal haemorrhages and cotton wool spots. Headaches, transient visual obscurations and horizontal diplopia referable to unilateral or bilateral sixth nerve palsies are the major neuro-ophthalmologic symptoms of elevated intracranial pressure.1

When dealing with children who are not always able to communicate their symptoms, it becomes critical to distinguish papilloedema from pseudopapilloedema, which is characterised ophthalmoscopically by small cupless discs with an increased number of major retinal vessels …

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