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JAMA Ophthalmology Clinical Challenge
June 11, 2020

Asymptomatic Papilledema in a 64-Year-Old Man

Author Affiliations
  • 1Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
  • 2Joint Department of Medical Imaging, Princess Margaret Hospital, Toronto, Ontario, Canada
JAMA Ophthalmol. Published online June 11, 2020. doi:10.1001/jamaophthalmol.2020.0875

A previously healthy 64-year-old man was referred for a neuro-ophthalmological evaluation of bilateral optic nerve head edema that was noticed 2 months previously during a routine optometric examination. He denied having any symptoms of increased intracranial pressure (ICP), including headaches, pulsatile tinnitus, and transient visual obscurations. Findings on computed tomography of the brain without contrast were unremarkable. He was then seen by an ophthalmologist who confirmed bilateral severe optic nerve edema and requested magnetic resonance imaging of the brain and orbits without contrast. It demonstrated signs of increased ICP, including empty sella, posterior flattening of the globes, and widened optic nerve sheaths, but no other abnormalities (Figure 1A).

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