Confused about eye results for 11yr. old

I have an 11 yr. old with unusual findings, papilledema without findings.  All test are -.  MRI without contrast, vision testing, angioplasty, ultrasound.  They found it last Sept. and no symptoms have surfaced.  They have not seen this before, and are trying to figure out where to send us--optha, neuro.  He has not had a spinal tap.  Will that be necessary and what test should we be expecting???  Hoping you can give us some insight into this situation.  Thank you

[John C Hagan III, MD, FACS, FAAO]

You need to see a neuro-ophthalmologist or if not available a general ophthalmologist (Eye MD) for a complete evaluation. Some of the possibilities: false papilledema (psuedo-papilledema) may be due to 'rock candy' like crystals buried in the optic nerve (optic nerve drusen), high hyperopia (farsightedness in one or both eyes), and several other less common. If your child does have true bilateral papilladema and the work up you describe is negative (especially if the child is obese, taking tetracyclines or steroids, high doses of some vitamens) this may be 'pseudo-tumor cerebri' also known as 'benigh intracracanial hypertension' a condition where the cerebral spinal fluid is being produced too fast and treated with a drug called Diamox. Your neurologist may need to to a spinal tap AFTER the ophthalmologist sees your child.

Good luck and let us know how things turn out.

JCH MD