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Bilateral optic disc swelling; is a CT scan necessary?

U K Bhatt1

  • 1Department of Ophthalmology, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. bhattuday@yahoo.com

Emergency Medicine Journal : EMJ
|October 26, 2005
PubMed
Summary

A head injury diagnosis led to the discovery of optic nerve head drusen (ONHD), a condition causing blurred optic discs. Early detection is crucial for managing visual field defects and preventing misdiagnosis of papilledema.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Radiology

Background:

  • Head injuries can present with varied symptoms, necessitating thorough diagnostic evaluation.
  • Optic disc abnormalities require careful differentiation between true swelling and pseudo-papilledema.

Observation:

  • A 47-year-old man with a head injury presented with bilateral blurred optic disc margins on ophthalmoscopy.
  • Initial head X-rays showed no fractures, but ophthalmic findings prompted further investigation.

Findings:

  • Ophthalmological examination and B-scan ultrasound confirmed bilateral optic nerve head drusen (ONHD).
  • Optic nerve head drusen are often asymptomatic but can cause visual field defects.

Implications:

  • Accurate diagnosis of ONHD is vital to avoid unnecessary neuroimaging and radiation exposure.
  • Patients with ONHD may require driving restrictions due to visual field constriction.
  • Genetic predisposition suggests family screening for optic nerve head drusen is advisable.

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