Journal article Open Access

Papilledema Due to Elevated Cerebrospinal Fluid Protein without Pleocytosis

Xu He; Zoë R. Williams

AbstractPurpose: To present the differential diagnosis and appropriate workup for patients with papilledema with elevated CSF total protein but no pleocytosis.Case Report: Many patients are referred to Neuro-ophthalmology with a diagnosis of idiopathic intracranial hypertension who do not fulfill the diagnostic criteria. This case illustrates an example of vision-impairing papilledema with elevated CSF total protein without pleocytosis secondary to diabetes, severe hypothyroidism and multi-level spinal stenosis with disk herniation, which was rapidly corrected by optic nerve sheath fenestration (ONSF) with restoration of baseline vision. His disease course was complicated by subretinal hemorrhage from peripapillary choroidal neovascularization (PPCNV), which resolved with three intravitreal injec-tions of bevacizumab.Conclusion: Thorough workup of papilledema with elevated CSF total protein without pleocytosis can lead to unveiling of uncom-mon etiologies of papilledema. If causative etiologies cannot be corrected rapidly, ONSF remains an effective method to relieve papilledema and to preserve vision.

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