Which of the following is not seen in papilledema: March 2009

Ans. D: Prominent optic disc margin Signs of papilledema: Early and mild Papilledema - Subtle gray peripapillary halo - Normal radial optic nerve head disrupted and nerve fibers accentuated by grayish opacity - Concentric folds of the retinochoroid Moderate Papilledema - Borders of optic disc become obscure - Disc margins are progressively elevated - Nerve head diameter increases - Major blood vessels leaving the disc are obscured Severe Papilledema - Optic Nerve head protrudes - Peripapillary halo demarcated Optic cup is obliterated Associated findings Loss of spontaneous retinal vein pulsations - Pulsations disappear at CSF Pressure > 250 mm water, Many normal patients lack venous pulsations (Unreliable sign) - Hyperemia - Retinal vessel touosity - Retinal hemorrhages - Retinal exudates - The radiating, oedematous folds around the macula take on the appearance of a macular star, usually incomplete and fan-shaped on the side towards the disc, while pluffy patches (cotton wool spots due to Nerve fiber infarctions) appear scattered throughout the posterior half of the fundus. - Optic Nerve pallor Papilledema shows a distended Optic Nerve sheath.