Papilledema: Treatment, Procedure, Cost and Side Effects

Papilledema is also known as papilloedema or optic disc swelling.

Papilledema refers to the condition in which due to increased pressure inside and around the brain results in the part of optic nerve inside the eye to swell. If not treated in time then papilledema can lead to loss of vision. A CT and MRI scan of the brain and the spinal cord is performed for further evaluation of the disease.

Since Papilledema occurs mostly due to intracranial pressure (which can also be a sign of a brain tumor), the more earlier it is diagnosed, the better. Treatment usually includes the usage of antibiotics, other medications and even steroids. Sometimes, a surgery becomes essential in order to remove the tumor (if any).

The treatment depends upon the underlying cause of Papilledema. With the help of CT and MRI, the cause can be diagnosed, whether it is a structural cause (tumor) or not and on the basis of this, the treatment is performed. In case a brain tumor is detected, surgery, radiation and laser treatments are performed to get rid of the tumor.

In order to decrease the intracranial pressure, medications are administered by increasing the absorption of the cerebrospinal fluid (CSF) or by decreasing its production. These medications include furosemide, acetazolamide etc. These diuretics help in weight loss which in itself can help in reducing the pressure inside the head by lessening the amount of fluid in the body as well as the amount of fluid the brain makes. Just the loss of 5-10% of the body weight can significantly decrease the symptoms and sometimes it can even cure papilledema.

Painkillers can be swallowed for bringing from the pressure inside the skulls. Topamax which is commonly used for migraines and seizures helps people in reducing body weight and as a result it lowers down the ICP.

Papilledema is most commonly found in obese women of the child bearing age. It is commonly seen in children with IIH as well. However, since papilledema varies in its severity, it should be noted that the in the wide variety of treatments available, they should only be meted out depending upon the severity of the disease. In case the scan reveals a tumor, surgery should be performed. The treatments can be performed on every age group, depending upon the extent of the disease.

Since papilledema can also be treated via weight loss and the use of diuretics, this treatment method should not be adopted in patients who are already underweight or not obese. The patients who have mild papilledema which does not interfere with their normal life patterns have no need to undergo surgeries for treatment. With the simple use of painkillers and antibiotics, the disease can be treated.

Since papilledema occurs due to rise in intracranial pressure (ICP), it brings along with it a routine of headaches, nausea, vomiting, and a feeling of discomfort. The treatments also yield the same feelings. Since steroids are also recommended to patients suffering from papilledema, the main side effects of the use of steroids is that they can also increase the ICP if there is even a tiny change in dosage.

For patients who undergo surgery, there are various risk factors attached to it. These can include shunt failure and closure or scarring of optic nerve fenestrations.

In case of surgery, the patient should remain within the observance of the doctor until they are fully healed. Extra pressure and stress should be avoided. The patient should also work to maintain their body weight since that also leads to papilledema. In case the treatment isn’t surgical but medicinal, the patient should regularly visit the physician in order to check the progress of the disease or when to stop the intake of antibiotics and painkillers etc.

In case of lumbar puncture treatment, after the procedure there will be pain in the lower back after the procedure for which doctors will prescribe painkillers.

In case the patient has undergone surgery, the proper recovery time can range from 2 weeks to even a month or more depending upon the physical health and the extent of surgery. For patients who simply use diuretics or antibiotics to treat papilledema, the recovery time is almost instant. Since papilledema is a disease which does not cause pain, patients often recover every quickly.

The cost of brain tumor surgery (which can be a cause of papilledema) ranges from INR 420,000 to 840,000/- The cost of acetazolamide and furosemide vary depending upon their dosage. The lumbar puncture treatment is used to remove the excess spinal fluid in the cranium. The price varies across cities and ranges from Rs. 200 to 1000/-

There are several researches which conclude that Intracranial Hypertension can reoccur. It’s said to be a long time chronic illness and with its recurrence, chances are that papilledema will also come back if the intracranial pressure increases its designated limit. The treatment results hence, are not permanent in nature if the cause behind papilledema is IPC instead of a tumor. While once the tumor has been removed, chances of its recurrence decline significantly, the same cannot be said for IIH and IPC.