Juxtapapillary subretinal hemorrhages in pseudotumor cerebri

We report two cases of pseudotumor cerebri with subretinal hemorrhages. Bilateral juxtapapillary subretinal neovascular membranes were present in one. A unilateral hemorrhage occurred adjacent to a small anomalous optic disc in the other. Subretinal hemorrhages in papilledema may occur from juxtapapillary subretinal neovascular membranes that evolve rapidly and then involute. The relationship of the appearance and subsequent evolution of such juxtapapillary subretinal neovascular membranes to the course of the intracranial pressure is discussed. Occurrence in one eye may presage occurrence in the other eye, making control of intracranial pressure important once one eye is afflicted. Fortunately, severe permanent visual loss remains unreported. Some anomalous small optic discs may be particularly at risk for subretinal hemorrhage from papilledema because preexisting axonal crowding is aggravated by the swelling of the optic nerve from elevated intracranial pressure. Conditions related to the Valsalva maneuver that chronically or intermittently elevate intracranial pressure further and produce elevated cephalic venous pressure should be avoided.