Abstract

P 166

Acute papilloedema with papillo-macular hemorrhage in a young man

Christoph Münzenberg1, Thomas Kalinski2, Gernot I. W.. Duncker1, Friedrich Paulsen3, Saadettin Sel1
1Klinik und Poliklinik für Augenheilkunde der Universität Halle/Wittenberg, 2Institut für Pathologie der Universität Magdeburg, 3Institut für Anatomie und Zellbiologie der Universität Halle/Wittenberg

Objective
Description of clinical findings and diagnostics for papilloedema of unknown cause.
Methods
Ophthalmological diagnostics with past medical history, slit-lamp examination, funduscopy OCT, ultrasound and MRI of the cranium as well as neurosurgical assessment.
Results
Referral of a 25-years-old apparently healthy man with an assumed diagnosis of a central vein occlusion in the better eye (oculus ultimus, right eye). On presentation, the patient experienced head aches 7 days ago accompanying with “black dots” on his right eye. No other symptoms were reported. Visual acuity R +1.75s-0.5c 148° = 20/20; L 2/20 unaided (known since childhood). Intraocular pressure was normotensive in both eyes. No signs for intraocular inflammation. Strabismus convergens in the left eye. Funduscopic examination revealed in his right eye a papilloedema with flame-shaped hemorrhages and a intraretinal bleeding in papillo-macular area. In his left eye, there were a slight papilloedema without any intraretinal bleedings. Because of the papilloedema in both eyes and no systemic inflammation, an MRI examination of the cranium was performed. Cranial MRI revealed a hydrocephalus internus with a tumor in the left ventriculus cerebri. On account of these findings and the danger of an acute compression of the brain stem, the patient was referred to the neurosurgical department for surgery. Histopathological examination showed a central neurocytoma (WHO grade II), which was confirmed from the reference center for tumors Duesseldorf.
Conclusions
Patient with poor symptoms and not essentially typical clinical findings can have life threatening diseases.

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