Volume 26, Number 1—January 2020
Research Letter
Diagnosis of Syphilitic Bilateral Papillitis Mimicking Papilloedema
Alicia Gonzalez-Martinez, Sonia Quintas
, Diego Celdrán Vivancos, José Cebrián, and José Vivancos
, Diego Celdrán Vivancos, José Cebrián, and José Vivancos
Table
Differential diagnosis of syphilitic optic disk swelling*
| Differential diagnosis | Clinical presentation | Visual acuity | Visual fields | Optic disk appearance | Other ocular abnormalities | Lumbar CSF opening pressure† | Orbital MRI |
|---|---|---|---|---|---|---|---|
| Papilloedema |
Headache, nausea, tinnitus, diplopia, neck stiffness, photophobia |
Normal to slow reduction (months) |
Enlarged blind spot |
Swollen |
Flame hemorrhages |
High |
Normal/flattening of the posterior sclera, dilation of the ONS, and protrusion of the optic disk head |
| Perineuritis |
Asymptomatic |
Normal |
Enlarged blind spot, constricted peripheral visual field |
Slightly swollen |
None |
Normal |
ONS and orbital fat expansion and enhancement |
| Anterior optic neuritis (papillitis) | Ocular pain, dyschromatopsia | Reduced (hours-days) | Enlarged blind spot, central scotomas, and other field abnormalities | Swollen | None/cellular activity in the posterior vitreous, patchy diffuse retinitis | Normal | Optic nerve gadolinium enhancement |
*CSF cerebrospinal fluid; MRI, magnetic resonance imaging; ONS optic nerve sheath.
†Normal lumbar CSF pressure: <25 cm H2O, <28 cm H2O in obese patients.
Page created: December 18, 2019
Page updated: December 18, 2019
Page reviewed: December 18, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.