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Title | Description | Type |
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2-53b - Venous Pulsations | On the disc, look for spontaneous venous pulsations. Spontaneous venous pulsations can be seen in the large trunks of veins at the level of the disc margin. They are normally present and seen in 37-90% of normals -- depending on the experience of the examiner and the shape of the disc. The spontaneo... | Image |
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2-6a - Little Red Discs | | Image |
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2-6b - Little Red Discs | | Image |
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2-7a - Disc Anatomy | The optic disc appearance is determined by: the size of the eye, the size of the scleral canal, how the nerve is inserted into the globe, the appearance of the lamina cribrosa, where myelination stops, and what is left behind in normal development. Even though this is a disc with a very large cup, i... | Image |
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3-3 - Bergmeister Papilla | | Image |
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3-31b - Papilledema Stages | Grading Papilledema: Stage 0 GRADING PAPILLEDEMA GRADING PAPILLEDEMA We grade papilledema in order to tell us how severe it is. The most sensible grading scheme has been provided by Lars Frisén. STAGE 0: This woman had documented increased intracranial pressure of 340 mm water. Very little if any ... | Image |
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3-32b - Papilledema Stages | Grading Papilledema: Stage 1 Stage 1 = C shaped blurring of the nasal, superior and inferior borders. Usually the temporal margin is normal. Also notice the chorio-retinal folds (arrows) that eminate toward the macula (m) | Image |
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3-33b - Papilledema Stages | Grading Papilledema: Stage 2 = Elevation of the disc margin 360 degrees. Since the blood vessels at the disc margin are not swollen or obscured, this disc could be mistaken for pseudo-papilledema. | Image |
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3-34c Papilledema Stages | Grading Papilledema: Stage 3 Stage 3 = Elevation of the entire disc with partial obscuration of the retinal vessels at the disc margin. Here the vessels are partly obscured and make the development into stage 3 easier to call. | Image |
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3-35a - Papilledema Stages | Grading Papilledema: Stage 4 Stage 4 = Complete obliteration of the cup and complete obscuration of at least some vessels on the surface of the disc. There may be small dilated capillaries on the disc that resemble telangiectasia. It is not the NFL infarcts or hemorrhages but the obscuration of the ... | Image |
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3-36a - Papilledema Stages | Grading Papilledema: Stage 5 Stage 5 = Dome-shaped appearance with all vessels being obscured. (Sometimes called "champagne cork" swelling--because of its dome shape.) | Image |
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3-4 - Tilted Disc | Tilted discs are normal variants caused by oblique insertion of the optic nerve to the globe. They can be and frequently are mistaken for papilledema. In this case the superior edge of the disc is tilted and appears elevated. This disc exhibits a nasal inferior tilt. | Image |
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3-56a - Sarcoid | | Image |
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3-59a - Glioma | This 45-year-old man presented with vision loss in his right eye; his examination showed severe disc swelling in this eye and vision loss on visual field testing (3-59a). MRI with fat saturation and enhancement and MRI with T2 signals also confirm an enlarged optic nerve. (3-59c) Excisional biopsy o... | Image |
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3-59c - Glioma | This 45-year-old man presented with vision loss in his right eye; his examination showed severe disc swelling in this eye and vision loss on visual field testing (3-59a). MRI with fat saturation and enhancement and MRI with T2 signals also confirm an enlarged optic nerve. (3-59c) Excisional biopsy o... | Image |
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3-5b - Myelinated Nerve Fibers | Myelinated nerve fibers are frequently confused with papilledema. The feathery edge of the myelinated fibers that conceal the disc and vessel should provide the clue. These myelinated nerve fibers make the disc look blurred. | Image |
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3-60a - Meningioma | This 35 year old woman presented with slowly progressive loss of central acuity to 20/30. 3-60a: Her visual field shows progressive restriction over time. 3-60b: Her disc was chronically swollen, with refractile bodies on the disc surface. 3-60d: The CT axial scan showed an enlarged calcified optic... | Image |
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3-60b - Meningioma | This 35 year old woman presented with slowly progressive loss of central acuity to 20/30. 3-60a: Her visual field shows progressive restriction over time. 3-60b: Her disc was chronically swollen, with refractile bodies on the disc surface. 3-60d: The CT axial scan showed an enlarged calcified optic... | Image |
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3-60d - Meningioma | This 35 year old woman presented with slowly progressive loss of central acuity to 20/30. 3-60a: Her visual field shows progressive restriction over time. 3-60b: Her disc was chronically swollen, with refractile bodies on the disc surface. 3-60d: The CT axial scan showed an enlarged calcified optic... | Image |
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3-64a - Shunt Vessels (CRVO) | This man with a chronic CRVO and retino-choroidal collaterals developed AION and his collaterals disappeared. CRVO with retinochoroidal collaterals is almost always associated with multiple peripheral dot and blot hemorrhages as well as nerve fiber layer infarcts of various ages. Notice the retino-c... | Image |
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3-65 - Shunt Vessels (Glaucoma) | Chronic end-stage glaucoma produces high pressure that interferes with venous drainage from the disc and broad smooth venous collaterals drain the disc centrifugally to the disc margin where they drain. | Image |
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3-66a - Shunt Vessels (Post-papilledema) | The retino-choroidal collaterals seen with chronic papilledema begin with a "Hairnet" of telangiectasias that gradually winnow down to one or more large collateral tortuous draining channel. The presence of these vessels is evidence of long standing disc swelling. When the CSF pressure is lowered, t... | Image |
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3-66d - Shunt Vessels (Post-papilledema) | The retino-choroidal collaterals seen with chronic papilledema begin with a "Hairnet" of telangiectasias that gradually winnow down to one or more large collateral tortuous draining channel. The presence of these vessels is evidence of long standing disc swelling. When the CSF pressure is lowered, t... | Image |
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4-35 - Cupped Optic Nerve | Atrophic Glaucoma Atrophic glaucomatous discs show thinning of the neuro-retinal rim, "saucerization" (which is shallow cupping), evidence of peripapillary atrophy, and pallor of the very narrow neuroretinal rim. Notice that there is severe atrophy of the nerve fiber layer. | Image |
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4-52b - Dominant Optic Neuropathy | A son presented with bilateral optic atrophy of unknown etiology after he failed a school visual exam. When looking for dominant optic atrophy, look at the parents. Mother was examined to find similar kind of atrophy. 4-52a mother, 4-52b son. | Image |