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Twin and triple peaks papilledema
Jodhbir S Mehta1, Gordon T Plant, James F Acheson
1Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom. jodmehta@gmail.com
Ophthalmology
|June 1, 2005
Summary
Twin peaks papilledema, a rare sign, can occur in adults. This case series describes two adult patients with papilledema, one with triple peaks due to a pituitary tumor and another with twin peaks from a chiasmal glioma.
Area of Science:
- Neuro-ophthalmology
- Neuroimaging
- Clinical Neurology
Background:
- Papilledema, or optic disc swelling, is a critical sign of elevated intracranial pressure.
- Band atrophy is a specific optic disc morphology that can precede or accompany papilledema.
- Twin peaks and triple peaks papilledema are rare variations of optic disc appearance in papilledema.
Observation:
- This study presents two adult cases of papilledema with distinct optic disc appearances.
- Case 1: A pituitary tumor caused papilledema with a "triple peaks" sign.
- Case 2: A chiasmal glioma led to papilledema exhibiting the "twin peaks" sign.
Findings:
- The "twin peaks" papilledema is a rare clinical sign associated with secondary raised intracranial pressure.
- The "triple peaks" papilledema, observed in one patient with a pituitary tumor, represents a newly described clinical sign.
- Neuroimaging modalities including optical coherence tomography (OCT) and magnetic resonance imaging (MRI) were crucial in diagnosis.
Implications:
- Twin peaks papilledema can manifest in adult patients, not exclusively in children.
- Triple peaks papilledema is identified as a novel clinical sign, expanding the spectrum of papilledema presentations.
- Recognition of these rare signs aids in the timely diagnosis of underlying intracranial pathologies.