# Chiari Malformation Type I With Concurrent Bilateral Optic Disc Drusen: Is Follow-up Necessary?

## TL;DR

This paper discusses a case where a young boy with Chiari malformation had optic disc drusen, which can look like papilledema, and highlights the need for regular eye exams to monitor changes.

## Contribution

The paper emphasizes the importance of multimodal imaging and annual follow-ups in patients with Chiari malformation and optic disc drusen to detect potential optic nerve changes.

## Key findings

- Optic disc drusen can mimic papilledema in patients with Chiari malformation type I.
- Multimodal imaging is essential to differentiate between optic disc drusen and true papilledema.
- Annual follow-ups are recommended to monitor for optic nerve head changes despite the presence of optic disc drusen.

## Abstract

Pseudopapilledema caused by optic disc drusen (ODD) mimics the appearance of papilledema and usually presents as a diagnostic challenge. A young boy with known Chiari malformation type 1 (CM-1) was referred to the pediatric ophthalmology clinic for eye assessment to exclude papilledema due to elevated intracranial pressure (ICP). Despite the ophthalmic examination revealing bilateral optic disc elevation, multimodal imaging techniques such as fundus autofluorescence, optical coherence tomography (OCT), and B-scan ultrasonography are recommended to confirm the distinction between bilateral ODD causing pseudopapilledema and papilledema secondary to elevated ICP.

Accidental coexistent papilledema mimickers like ODD need to be considered in patients with CM-1 before making a diagnosis of papilledema to avoid unnecessary invasive procedures. There was no evidence that the presence of ODD excludes the possibility of future optic nerve head changes due to elevated ICP. The multidisciplinary consensus decided on annual ophthalmology follow-ups using multimodal imaging to detect any subtle optic nerve head changes.