Published online Sep 26, 2017. doi: 10.5662/wjm.v7.i3.108
Peer-review started: February 8, 2017
First decision: June 12, 2017
Revised: July 22, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: September 26, 2017
To study the usefulness of orbital ultrasonography in the diagnosis of papilledema.
Fifty patients who were referred to the neurophthalmology clinic and clinically suspected to have papilledema were selected. Thorough, clinical examination with slitlamp biomicroscopy and visual acuity assessment was done. These patients underwent ultrasonography to demonstrate the crescent sign. The patients were further evaluated with the neurologist and magnetic resonance imaging (MRI) thus confirming the diagnosis of papilledema. The results of our ultrasonographic evaluation were correlated with final diagnosis after thorough clinical evaluation, imaging and the neurologist’s opinion.
Out of 50 patients diagnosed having papilledema on MRI, 46 (92%) showed crescent sign on B scan ultrasonography. Headache was most common presenting complaint in 47 (94%) and idiopathic intracranial hypertension was most common underlying cause of papilledema in 30 (60%) cases.
“Crescent sign” seen on ultrasonography is a sensitive tool for diagnosis of papilledema. It is cost effective, less cumbersome and effective tool to differentiate between papilledema and pseudo papilledema before subjecting the patients to costly investigations like MRI. A positive crescent sign should always be followed by MRI to find out the cause of papilledema.
Core tip: It is a retrospective study of 50 clinically diagnosed cases of papilledema where 46 cases showed a positive crescent sign on ocular ultrasonography. With an accuracy of 92%, ocular ultrasonography could be a cheaper and useful tool to confirm papilledema before subjecting these patients for MRI scans.