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Optic Disc Drusen vs Papilloedema — SCE Neurology MCQ

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HardNeuro-ophthalmologyOptic Disc Drusen vs PapilloedemaSCE Neurology

A child has elevated irregular optic discs but no vessel obscuration or haemorrhage. Autofluorescence and B-scan ultrasound show calcified deposits within both nerve heads. Which diagnosis explains the appearance?

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Correct answer: E — Optic-disc drusen causing pseudopapilloedema, after excluding the closest mimic

The best answer is “Optic-disc drusen causing pseudopapilloedema, after excluding the closest mimic”. Calcified deposits and a lumpy disc contour without the vascular signs of oedema indicate optic-disc drusen, while symptoms of raised pressure would still require independent assessment. “Raised intracranial pressure causing true papilloedema” is plausible in a different neurological context, but the decisive findings here argue against it. “Demyelinating optic neuritis” is plausible in a different neurological context, but the decisive findings here argue against it. “Anterior ischaemic optic neuropathy” is plausible in a different neurological context, but the decisive findings here argue against it. “Infectious papillitis” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: Royal College of Ophthalmologists commissioning guide: adult low vision and inherited retinal disease: https://www.rcophth.ac.uk/resources-listing/commissioning-guidance/