Background: In principle, papilledema due to intracranial hypertension can occur bilaterally. Here, we present the case of a patient who was diagnosed with chronic subdural hematoma after the detection of a unilateral optic disc swelling.
Case: A 71-year-old man underwent cataract surgery in both his right and left eyes at a nearby ophthalmology clinic in January 20XX and February 20XX, respectively. On May 15,20XX, during a follow-up visit to a nearby ophthalmologist, right optic disc swelling was observed and the patient was referred to our hospital for close examination. At the initial visit to our hospital on May 18,20XX, fundoscopy revealed severe optic disc swelling with preservation of central cupping in the right eye. In both eyes, the best-corrected visual acuity was good and the critical flicker fusion frequency was normal. Optical coherence tomography showed remarkable thickening of the peripapillary area of the right eye, while the peripapillary area of the left eye was within the reference range. The Goldmann perimetry test revealed enlargement of the Mariotte blind spot in the right eye. Optic neuritis and compressive optic neuropathy were suspected; however, blood test results were normal. We suspected intracranial disease and interviewed the patient again. He reported that he fainted and bruised his head in February 20XX. He presented to the neurosurgery department of a local hospital, and the results of the head computed tomography (CT) were normal. He began having difficulty moving his left leg around April 20XX. Head CT taken at our hospital revealed bilateral right dominant chronic subdural hematomas. A right burr hole drainage of hematoma was performed on the same day at our neurosurgery department. Thereafter, gait disturbance and papilledema improved as the hematoma shrank.
Conclusion: Given the possibility of an intracranial lesion in patients with unilateral optic disc swelling, a detailed interview and examination should be conducted for them.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 614-620, 2023.