Papilloedema as a single prognostic factor in moderate head injured adult patients

Abstract

Background & objectivePapilledema is optic disc swelling due to high intracranial pressure (ICP). Bilateral papilledema is caused by increased subarachnoid pressure around the optic nerves, a phenomenon that is usually accompanies the elevated ICP in patients exposed to significant head trauma, and since it is a bedside diagnosis, it could be performed initially on admission and repeated whenever required, to find out the value of tracking papilledema and its impact on prognosis in moderate head trauma in absence of ICP monitoring. Patients and methodsA number of selected 72 adult patients, admitted to emergency hospital, who sustained isolated moderate head injury (GCS = 9–12), with proven CT scan brain devoid of either immediate or delayed intracranial mass lesion, or any significant surgical indications (e.g. depressed fracture). Patients with anterior fossa fracture were also excluded when associated with periorbital swelling, oedema, or ecchymosis, as well as cases who developed post traumatic cranial nerve palsy related to eyes (e.g. oculomotor nerve palsy), also cases that necessitated mechanical ventilation were excluded in this study. Bilateral fundoscopy was done, initially within 24 h of admission, then in the next 3rd day, while patients subjected to the regular indicated medical management. Glasgow outcome score (GOS) was identified to all patients after two weeks of admission, after routine follow up CT brain to rule out development of new intracranial lesions. ResultsThe study comprised 72 patients (males = 48, females = 24), with age range (23–52 years). GCS on admission = (9 for 8 patients, 10 for19, 11 for 21, and 12 for 24 patients). Bilateral papilloedema found in 23 cases in the early 24 hrs, then in 14 more patients at 72 hrs (total = 37). CT scan revealed NAD in 35 cases, brain edema in12, surface contusions in 18, SAH in 8, and pneumocephalus in 4 cases. Patients who developed early papilloedema that persist to 72 hrs., were associated with the worst GOS, compared to those who were free of papilloedema from the start (the group with the best GOS). Whereas those who developed late papilloedema (at 72hrs) showed better GOS. ConclusionTracking papilloedema may be useful in early outcome prediction in moderate head injured adult patients, besides its value in detection and control of increased intracranial tension.