Idiopathic intracranial hypertension: Imaging and clinical fundamentals

Table 1 Frisén Scale - papilledema grading system

Frisén Scale - papilledema grading system
Stage 0: Normal optic disc	Retinal NFL prominence at the nasal, superior, and inferior poles in an inverted proportion to disc diameter
	Radial NFL striations - no tortuosity
	Rarely obscuration of a major blood vessel, usually on the upper pole
Stage 1: Very early papilledema - minimal degree of edema	No elevation of the disc borders
	Obscuration of the nasal border of the disc
	Normal temporal disc margin
	Disruption of the normal radial NFL arrangement striations
	Subtle and grayish halo (C-shaped) with temporal gap; underlying retinal details obscured
	Concentric or radial choroidal folds
Stage 2: Early papilledema - low degree of edema	Obscuration of all borders
	Circumferential halo
	Elevation of the nasal border
	No obscuration of any major vessel
Stage 3: Moderate papilledema - moderate degree of edema	Obscurations of all borders
	Circumferential halo
	Obscuration of one or more segments of major blood vessels leaving the disc
	Elevation of all borders
	Peripapillary halo-irregular outer fringe with finger-like extensions
Stage 4: Marked papilledema - marked degree of edema	Total obscuration of a segment of a major blood vessel on the disc
	Elevation of the entire nerve head, including the cup
	Obscuration of all borders
	Complete peripapillary halo
Stage 5: Severe papilledema - severe degree of edema	Dome-shaped protrusions representing anterior expansion of the optic nerve head
	Peripapillary halo is narrow and smoothly demarcated
	Partial obscuration of all vessels and total obscuration of at least one major blood vessel on optic disc
	Obliteration of the optic cup

Adapted from Scott et al[59]. NFL: Nerve fiber layer.