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—The term papilledema is clearly defined as bilateral (or rarely unilateral) optic disc swelling due to elevated intracranial pressure (ICP). Patients with acute papilledema typically have normal visual parameters except for enlargement of the blind spots. Our patient presented with headaches, marked swelling of both optic nerves, and normal vision, the classic constellation of symptoms and signs seen in patients with elevated ICP. In addition, anemia as severe as that documented in our patient (hemoglobin level, 42 g/L) is a well-known cause of increased ICP. I can only assume that Dr Lubow's statement that "The signs, symptoms, and computed tomographic (CT) scan results do not suggest that increased intracranial pressure was present" represents an oversight. I should also point out that normal results of CT cannot be construed as evidence against elevated ICP. On the contrary, CT findings are normal in the majority of patients with pseudotumor cerebri.
Pollock SC. 'Pseudo' Pseudotumor Cerebri in Aplastic Anemia-Reply. Arch Ophthalmol. 1991;109(12):1638. doi:10.1001/archopht.1991.01080120016010
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