WordNet

fail to perform adequately due to tension or agitation; "The team should have won hands down but choked, disappointing the coach and the audience"
constrict (someones) throat and keep from breathing (同)strangle
reduce the air supply; "choke a carburetor" (同)throttle
breathe with great difficulty, as when experiencing a strong emotion; "She choked with emotion when she spoke about her deceased husband"
a coil of low resistance and high inductance used in electrical circuits to pass direct current and attenuate alternating current (同)choke coil, choking coil
a valve that controls the flow of air into the carburetor of a gasoline engine
be too tight; rub or press; "This neckband is choking the cat" (同)gag, fret
wring the neck of; "The man choked his opponent" (同)scrag
check or slow down the action or effect of; "She choked her anger"
stopped up; clogged up; "clogged pipes"; "clogged up freeways"; "streets choked with traffic" (同)clogged

PrepTutorEJDIC

…'を'『息を止める』,'を'窒息させる / (…で)…'を'むせさせる,息苦しくする《+『名』+『with』(『by』)+『名』》 / (…で)…'を'いっぱいにする,ふさぐ,(…を)…‘に'ぎっしり詰める《+『名』+『up』(+『up』+『名』)+『with』+『名』》 / …'を'進行(動き)を止める / 『息が詰まる』,窒息する / (…で)むせぶ,息苦しくなる《+『with』+『名』》 / 〈U〉〈C〉窒息,息が詰まること / (パイプの中などの)閉塞(へいそく)部 / 〈C〉(電気器具の)チョークコイル / 〈C〉チョーク(ガソリンエンジンの空気調整装置)
=record / =disk

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/20 10:12:22」(JST)

wiki en

Papilledema (or papilloedema) is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare. Papilledema is mostly seen as a symptom resulting from another pathophysiological process.

In intracranial hypertension, papilledema most commonly occurs bilaterally. When papilledema is found on fundoscopy, further evaluation is warranted as vision loss can result if the underlying condition is not treated. Further evaluation with a CT or MRI of the brain and/or spine is usually performed. Unilateral papilledema can suggest orbital pathology, such as an optic nerve glioma.

Signs and symptoms

Fundal photograph showing less severe papilledema

Papilledema may be asymptomatic or present with headache in the early stages. However it may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision may occur.

The signs of papilledema that are seen using an ophthalmoscope include:

venous engorgement (usually the first signs)
loss of venous pulsation
hemorrhages over and / or adjacent to the optic disc
blurring of optic margins
elevation of optic disc
Paton's lines = radial retinal lines cascading from the optic disc

On visual field examination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged.

Diagnosis

Checking the eyes for signs of papilledema should be carried out whenever there is a clinical suspicion of raised intracranial pressure, and is recommended in newly onset headaches. This may be done by ophthalmoscopy or fundus photography, and possibly slit lamp examination.

Causes

Raised intracranial pressure as a result of one or more of the following:

Brain tumor, Pseudotumor Cerebri (also known as Idiopathic Intracranial Hypertension), Cerebral venous sinus thrombosis or Intracerebral hemorrhage
Respiratory failure^[1]
Hypotonia
Isotretinoin, which is a powerful derivative of Vitamin A, rarely causes papilledema.
Hypervitaminosis A, in some people who take megadoses of nutritional supplements and vitamins.
Hyperammonemia, elevated level of ammonia in blood (including cerebral edema/intracranial pressure)
Guillain-Barré syndrome, due to elevated protein levels
Foster Kennedy syndrome (FKS)
Chiari Malformation
Tumors of the frontal lobe
Acute Mountain Sickness and High-altitude cerebral edema
Lyme disease (Lyme meningitis specifically, when the bacterial infection is in the central nervous system, causing increased intracranial pressure).
Malignant Hypertension
Medulloblastoma
Orbital
- Glaucoma: Central retinal vein occlusion, Cavernous sinus thrombosis
- Local lesion: Optic neuritis, Ischemic optic neuropathy, Methanol poisoning, infiltration of the disc by Glioma, Sarcoidosis and Lymphoma
Acute Lymphocytic leukemia (caused by infiltration of the retinal vessels by immature leukocytes)
Long periods of weightlessness (microgravity) for males^[2] (See also Visual Impairment and Intracranial Pressure)

Pathophysiology

As the optic nerve sheath is continuous with the subarachnoid space of the brain (and is regarded as an extension of the central nervous system), increased pressure is transmitted through to the optic nerve. The brain itself is relatively spared from pathological consequences of high pressure. However, the anterior end of the optic nerve stops abruptly at the eye. Hence the pressure is asymmetrical and this causes a pinching and protrusion of the optic nerve at its head. The fibers of the retinal ganglion cells of the optic disc become engorged and bulge anteriorly. Persistent and extensive optic nerve head swelling, or optic disc edema, can lead to loss of these fibers and permanent visual impairment.

Treatment

Historically, papilledema was a potential contraindication to lumbar puncture, as it indicates a risk for tentorial herniation and subsequent death via cerebral herniation, however newer imaging techniques have been more useful at determining when and when not to conduct a lumbar puncture.^[3] Imaging by CT or MRI is usually performed to elicit whether there is a structural cause i.e. tumor. An MRA and MRV may also be ordered to rule out the possibility of stenosis or thrombosis of the arterial or venous systems.

The treatment depends largely on the underlying cause. However, the root cause of papilledema is the increased intracranial pressure (ICP). This is a dangerous sign, indicative of a brain tumor, CNS inflammation or idiopathic intracranial hypertension (IIH) that may become manifest in the near future.

Thus, a biopsy is routinely performed prior to the treatment in the initial stages of papilledema to detect whether a brain tumor is present. If detected, laser treatment, radiation and surgeries can be used to treat the tumor.

To decrease ICP, medications can be administered by increasing the absorption of Cerebrospinal fluid (CSF), or decreasing its production. Such medicines include diuretics like acetazolamide and furosemide. These diuretics, along with surgical interventions, can also treat IIH. In IIH, weight loss (even a loss of 10-15%) can lead to normalization of ICP.

Meanwhile, steroids can reduce inflammation (if this is a contributing factor to increased ICP), and may help to prevent vision loss. However, steroids have also been known to cause increased ICP, especially with a change in dosage. However, if a severe inflammatory condition exist, such as multiple sclerosis, steroids with anti-inflammatory effects such as Methylprednisolone and prednisone can help.

Other treatments include repeated lumbar punctures to remove excess spinal fluid in the cranium. The removal of potentially causative medicines including tetracyclines and vitamin A analogues may help decrease ICP, however this is only necessary if the medication is truly felt to contribute to ICP increase.

References

^ Cameron AJ (1933). "Marked papilloedema in pulmonary emphysema". Br J Ophthalmol 17 (3): 167–9. doi:10.1136/bjo.17.3.167. PMC 511527. PMID 18169104.
^ Rich Phillips (2012-02-10). "Astronaut feels space's toll on his body". CNN. Retrieved 2012-03-01.
^ "Papilledema and lumbar puncture risk.". J Neurol Neurosurg Psychiatry. 1987 August; 50(8): 1071–1074.

External links

eNotes

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 小児および思春期における「窒息ゲーム」およびその他の首絞め行動 the choking game and other strangulation activities in children and adolescents
2. 小児における気道異物 airway foreign bodies in children
3. 幼児、未就学児、および就学児に対して推奨される食事 dietary recommendations for toddlers preschool and school age children
4. 小児における急性上気道閉塞の緊急評価 emergency evaluation of acute upper airway obstruction in children
5. 小児における喘息以外の喘鳴疾患 wheezing illnesses other than asthma in children

English Journal

A case of Bardet-Biedl syndrome complicated with intracranial hypertension in a Japanese child.

Saida K1, Inaba Y2, Hirano M3, Satake W4, Toda T4, Suzuki Y5, Sudo A1, Noda S1, Hidaka Y1, Hirabayashi K6, Imai H6, Kurokawa T6, Koike K1.
Brain & development.Brain Dev.2014 Sep;36(8):721-4. doi: 10.1016/j.braindev.2013.10.013. Epub 2013 Nov 26.
Bardet-Biedl syndrome (BBS) is a rare heterogeneous autosomal recessive disorder characterized by rod-cone dystrophy, postaxial polydactyly, truncal obesity, hypogonadism, learning disability, and renal anomaly that are caused by ciliary dysfunction. 16 genes have been associated with the BBS phenot
PMID 24290075

Pseudotumor cerebri/idiopathic intracranial hypertension in children: An experience of a tertiary care hospital.

Değerliyurt A1, Teber S2, Karakaya G3, Güven A2, Seker ED4, Arhan EP2, Sayli TR3.
Brain & development.Brain Dev.2014 Sep;36(8):690-9. doi: 10.1016/j.braindev.2013.09.007. Epub 2013 Oct 16.
Objective: Pseudotumor cerebri (PTC) is diagnosed at increasing rates probably due to the increase in obesity prevalence all over the world and awareness about the disease. Our aim in this study was to evaluate the PTC clinical picture and etiological factors in children at the present time. Method:
PMID 24139858

Headache and the pseudotumor cerebri syndrome.

Mallery RM1, Friedman DI, Liu GT.
Current pain and headache reports.Curr Pain Headache Rep.2014 Sep;18(9):446. doi: 10.1007/s11916-014-0446-z.
Pseudotumor cerebri syndrome (PTCS) refers to the primary and secondary disorders that cause elevated intracranial pressure without an intracranial mass lesion, ventriculomegaly, or central nervous system infection or malignancy. Headache is the most frequent symptom of PTCS, but there is considerab
PMID 25086688

Japanese Journal

うっ血乳頭を合併した脳脊髄液減少症の1例

神経眼科 31(3), 331-335, 2014
NAID 130005057103

両視神経乳頭腫脹の経過中に静脈洞血栓と硬膜動静脈瘻が発見された糖尿病の1例

眼科臨床紀要 6(2), 97-103, 2013
NAID 40019589568

Hemangiopericytoma in the Lateral Ventricle : Case Report

Neurologia medico-chirurgica = 神経外科 49(11), 520-523, 2009-11-15
NAID 10025949132

Related Pictures

★リンクテーブル★

リンク元	「乳頭浮腫」「うっ血乳頭」
関連記事	「choke」「disc」「choked」「DISC」

「乳頭浮腫」

Papilledema
	Classification and external resources
	Fundal photograph showing severe papilloedema in the right eye
ICD-10	H47.1
ICD-9	377.0
DiseasesDB	9580
MeSH	D010211

　　[★]

英: papilledema, disk edema, optic disc edema(SOP)
ラ: papilla oedematosa
関: うっ血乳頭 choked disc　←　同義語ではない

原因を問わず視神経乳頭が腫脹している状態

乳頭浮腫の眼底所見(SOP.163)

乳頭の発赤
乳頭縁の境界不明瞭化
静脈の拡張とうっ血
乳頭面の隆起
乳頭の表在性出血
軟性白斑
網膜血管走行の不明瞭化
視力：原則視力の低下は起こらない。例外：(1)黄斑部に浮腫が伸展した場合、(2)乳頭浮腫が高度かつ長期にわたり続発性視神経萎縮の起こった場合、(3)うっ血乳頭の原因となった頭蓋内病変に基づく視力障害。
視野：視野の狭窄は起こらない。

索引

CNUR. 35
YN. C165 J15 {乳頭浮腫}
BET. 110,271
SCN. 40
M. 600
IMD 71
SOP. 133,163
 -～の眼底像. 163

-papilledema
DIF. 342
SCN. 40
SOP. 133
BET. 110,271
APT. 
PHD. 326
NEL. 2106,2107f,2435,2435f,2606-2607
 -due to pseudotumor cerebri. 2525
PON. 
 -acute. 237
 -chronic. 237f,237-238
 -in coma. 355
 -differential diagnosis in. 236
 -in intracranial pressure increase. 13,236-238,355,594
 -in intracranial tumors. 617
 -lumbar puncture risk in. 13
 -mild. 236,236f
 -optic disc swelling in. 232,233t,236-238
 -in pseudotumor cerebri. 237,601,602,603,604,605

-optic disc edema
SOP. 163

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