Stages of Papilledema

Kathleen B. Digre MD James J Corbett MD

Frisn Scale of Papilledema Grade 0 Papilledema

Look at NFL, cup, vessels, swelling

Minimal swelling of the nasal margin

NFL clear No vessel

obscuration Cup if present not

obscured

Frisn Scale Grade 1 Papilledema

230 degree C-shaped swelling of the nasal, superior and inferior borders

Temporal margin is normal with sharp disc margin

Cup if present is maintained

Frisn Scale Grade 2 Papilledema

Elevation of the temporal margin

360 disc swelling No major vessel

obscuration

Frisn Scale Grade 3 Papilledema

Elevation of the entire disc

360 degrees swelling

Partial Vessel obscuration at disc margin

Cup may be obscured

Frisn Scale Grade 4 Papilledema

NFL opaque/360 swelling

Vessels largely, but not completely, obscured on disc surface and lost at the margins

Frisn Scale Grade 5 Papilledema

NFL opaque/360 swelling

Vessels obscured on

disc surface

Non-essential, but common incidental findings in papilledema

Splinter, sub-retinal, pre-retinal and intraretinal hemorrhages

Retinal and choroidal folds Patons lines Nerve fiber layer infarcts Venous tortuosity Partial macular star AION, BRAO, CRAO and vein occlusion Retino-choroidal collateral veins

Hemorrhages

Incidental Findings: PAPILLEDEMA--Folds

Patons Lines Choroidal folds

Nerve Fiber layer infarcts and partial macular star

ATROPHIC PAPILLEDEMA

Gliosis Pallor High water marks

UNILATERAL PAPILLEDEMA

The non-swollen nerve is protected from high ICP by a tight optic canal

RESOLVING PAPILLEDEMA

OD OS

Stages of PapilledemaFrisn Scale of Papilledema Grade 0 PapilledemaLook at NFL, cup, vessels, swellingFrisn Scale Grade 1 PapilledemaFrisn Scale Grade 2 PapilledemaFrisn Scale Grade 3 PapilledemaFrisn Scale Grade 4 PapilledemaFrisn Scale Grade 5 PapilledemaNon-essential, but common incidental findings in papilledemaSlide Number 9Incidental Findings: PAPILLEDEMA--FoldsSlide Number 11ATROPHIC PAPILLEDEMAUNILATERAL PAPILLEDEMASlide Number 14