Findings in papilledema:
(1) elevation of the optic disc with blurring of the disc margin
(2) opacification of the peri-papillary nerve fiber layer
(3) dilatation of the pre-papillary capillary plexus
(4) hyperemia
(5) dilatation of large veins
(6) loss of the optic disc cup
(7) splinter hemorrhages (within 1 disc diameter of the disc margin)
(8) cotton wool spots
(9) loss of spontaneous pulsations
Criteria for severe papilledema – one or both of the following:
(1) marked elevation of the disc with blurred margin AND loss of the optic disc cup
(2) any elevation of the disc with >= 5 disc hemorrhages
Criteria for moderate papilledema – one or more of the following:
(1) any abnormal elevation of the disc AND 1 to 4 disc hemorrhages
(2) any abnormal elevation of the disc AND dilated pre-papillary capillaries
(3) abnormal elevation of the disc with blurring of the margin in all 4 quadrants
Criteria for mild papilledema – both of the following:
(1) no disc hemorrhages
(2) abnormal elevation of the disc with blurring of the margin in 1 to 3 quadrants
The presence of papilledema is a poor prognostic sign for a comatose child with cerebral malaria.
Papilledema is not specific for cerebral malaria. If other retinal signs of malaria are absent then other causes of coma should be considered.
