Which sign on ophthalmologic exam is classically associated with raised intracranial pressure?

• A. Cotton-wool spots.
• B. Papilledema.
• C. Ptosis.
• D. Optic neuritis.

Answer: (B)

Raised intracranial pressure affects the optic nerves by transmitting pressure along the subarachnoid space around the optic nerve, causing swelling of the optic disc known as papilledema. This is the classic sign because it directly reflects elevated cerebrospinal fluid pressure reaching the optic nerve head. On exam you typically see bilateral optic disc edema with blurred margins, possible venous congestion, and sometimes flame-shaped hemorrhages. Over time, sustained pressure can lead to optic atrophy and progressive vision loss.

Cotton-wool spots are microinfarcts of the retinal nerve fiber layer from systemic vascular disease such as diabetes or hypertension, not a direct sign of raised ICP. Ptosis is eyelid drooping from oculomotor nerve palsy or Horner syndrome, unrelated to intracranial pressure dynamics. Optic neuritis is an inflammatory condition of the optic nerve, often presenting with acute unilateral vision loss and pain with eye movement, not a sign of increased ICP.