Real or Fake? We Can All Make a Mistake

The task of accurately identifying papilledema and distinguishing it from pseudopapilledema can be especially challenging in children. Two clinical cases are presented to highlight how subtle this distinction can be and the difficulty in correctly diagnosing underlying pathology and treating it promptly. With a focus on how easily a diagnosis of craniosynostosis can be missed, these cases also provide a springboard for reviewing several subtle clues that can help make an accurate diagnosis. Recent advances in imaging and other technology, as well as the interrelated pathophysiology of papilledema, pseudopapilledema, and craniosynostosis are reviewed.