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January 19, 1963


JAMA. 1963;183(3):202-203. doi:10.1001/jama.1963.03700030078016

In 1933 Cameron1 first reported the presence of papilledema in a patient with emphysema, and later investigators set the incidence of papilledema in patients with chronic pulmonary disease at 10%. Because the papilledema secondary to cardiopulmonary insufficiency was also associated with an impairment of consciousness and a disorder of movement, patients were occasionally admitted to the hospital with a presumptive diagnosis of brain tumor.2, 3 Austen and associates2 described three such patients and noted that the disorder of movement resembled the "flapping" tremor of hepatic coma, termed asterixis.4 The disorder of consciousness is directly attributable to carbon dioxide retention. The development of papilledema apparently requires a combination of hypercapnia, hypoxia, and congestive heart failure; the latter acutely aggravates the existing blood gas abnormalities and produces edema and congestion of the brain. The mechanism of the disorder of movement remains obscure and is not related in a

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