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J Neurocrit Care 2012;5(2): 33-39.
신경계 중환자실에서 안저 소견: 유두부종을 중심으로
김 성 희·박 기 덕
이화여자대학교 의학전문대학원 목동병원 신경과학교실
Funduscopic Findings in Neurologic Intensive Care Unit:With the Focus on Papilledema
Sung-Hee Kim, MD and Kee Duk Park, MD, PhD
Department of Neurology, Ewha Womans University School of Medicine, Mokdong Hospital, Seoul, Korea
Papilledema is defined as swelling of the optic nerve head related to increased intracranial pressure (ICP). Papilledema is a quite reliable indicator of chronically increased ICP, and able to be detected easily at bedside using ophthalmoscope. Knowledge about features of both normal fundus and papilledema is required for all the practicians in neurocritical care unit. The recognition of papilledema is very important clinically because it is the most important clinical sign of raised ICP. Optic nerve sheath is not as rigid as other intracranial meningeal structures and thus able to react to the pressure of the cerebrospinal fluid (CSF) space. The major mechanism of papilledema for substantial optic nerve damage is axoplasmic flow stasis and resultant intraneuronal ischemia. The degree of optic nerve head swelling, however, is not necessarily correlated with the degree of raised intracranial pressure. Also the degree of papilledema cannot predict the severity of clinical symptom such as visual field change. When observing fundus of a patient in neurocritical care unit, therefore, the fact that increased CSF pressure might produce various disc abnormalities is worth to be remembered.
Key Words: Fundus · Papilledema · Neurocritical care unit · Increased intracranial pressure
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