Snapshot A 58-year-old man presents to the emergency department with transient vision loss in both eyes. His symptoms are associated with a throbbing right frontal headache. He endorses an unintentional 25 pound loss over the course of 3 months. Physical examination is notable for bilateral papilledema. An MRI brain with and without contrast demonstrates a right frontal intra-axial mass concerning for malignancy. Overview optic disc swelling secondary to increased intracranial pressure Etiology Pathophysiology raised intracranial pressure is transmitted to the optic nerve sheath this disrupts axoplasmic nerve flow, leading to leakage of intracellular contents, and subsequently resulting in optic disc swelling Associated conditions intracranial mass cerebral edema idiopathic intracranial hypertension obstructive hydrocephalus obstructive venous flow (e.g., venous sinus thrombosis) Presentation Symptoms transient vision loss with changes in head position or spontaneously Physical exam typically bilateral findings loss of venous pulsation obliteration of the optic nerve cup optic disc swelling disc margins become obscured Imaging Brain imaging indication initial step in the evaluation of increased intracranial pressure suggested by papilledema modality MRI brain with contrast is preferred Studies Lumbar puncture indication in patients with papilledema with normal neuroimaging to assess opening pressure Visual field testing indication to monitor visual side effects of papilledema response to treatment Differential Optic neuritis differentiating factors typicailly unilateral relative afferent pupillary defect in unilateral cases pain associated with eye movements Treatment Treatment is aimed at the underlying cause of papilledema e.g., tumor resection in patients with a brain malignancy Complications Blindness