Papilloedema and raised intracranial pressure
Telling papilloedema from pseudopapilloedema, the same-day work-up for raised intracranial pressure, the Friedman criteria for IIH, and protecting vision with weight loss, acetazolamide and surgery.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Papilloedema is disc swelling from raised intracranial pressure (ICP). It is usually bilateral, and acuity is preserved until late.
- Treat it as a same-day emergency: measure BP, image for mass, hydrocephalus and cerebral venous sinus thrombosis (CVST), then do an LP with opening pressure if imaging allows.
- The commonest cause in young women with obesity is idiopathic intracranial hypertension (IIH). It is a diagnosis of exclusion.
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Sources
- Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children (Friedman DI et al. Neurology 2013;81(13):1159-1165)Neurology, 2013
- Idiopathic intracranial hypertension: consensus guidelines on management (Mollan SP et al. J Neurol Neurosurg Psychiatry 2018;89(10):1088-1100)Journal of Neurology, Neurosurgery and Psychiatry, 2018
- Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the IIH Treatment Trial (JAMA 2014;311(16):1641-1651)NORDIC Idiopathic Intracranial Hypertension Study Group, JAMA, 2014
- Effectiveness of bariatric surgery vs community weight management intervention for idiopathic intracranial hypertension: IIH:WT randomized clinical trial (Mollan SP et al. JAMA Neurology 2021;78(6):678-686)JAMA Neurology, 2021
- Diagnosis, treatment and monitoring of idiopathic intracranial hypertension: consensus recommendations of the Austrian IIH network (Bsteh G et al. Cephalalgia 2025;45(11))Cephalalgia, 2025
- Therapeutic Guidelines: NeurologyAU/NZTherapeutic Guidelines Limited
- Assessing Fitness to Drive (AP-G56), Vision and eye disordersAU/NZAustroads and National Transport Commission, 2022
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy