Papilledema in patients with severe pulmonary emphysema.

Abnormalities of function of the central nervous system that occur in association with severe pulmonary emphysema have been reported with increasing frequency. This trend may represent an increase in the actual incidence of severe emphysema but it also may reflect a better understanding of mechanisms involved and consequently a greater index of awareness by clinical observers. The paradoxical manifestations of both depression and irritability of the central nervous system have been attributed to hypoxia, hypercapnia, polycythemia, cor pulmonale and alterations in cerebral blood flow with associated increase in cerebrospinal fluid pressure. A small portion of these patients manifesting one or more of the features of headache, mental cloudiness and muscular twitching in addition to signs of pulmonary insufficiency may be found to have varying degrees of papi1ledema.’ ” Sieker and Hickam7 reported that one patient in their series of 25 patients with classic carbon dioxide intoxication complicating severe chronic pulmonary insufficiency had papilledema. Numerous others have described the finding of papilledema in such patients which usually led to detailed investigation of the central nervous system to eliminate the possibility of an expanding intracranial lesion. The patient’s altered sensorium often thwarted the physician’s efforts to elicit the cause of the papilledema and necessitated the accumulation of objective evidence to exclude the presence of a brain tumor. The purpose of this paper is to add to the small but growing number of cases which have been reported and to gain additional information about the clinical ramifications of this problem.