NeuroOp Guru: Can a dead nerve swell?

This latest episode of the NeuroOp Guru—hosted by Andrew G. Lee, MD, from Houston Methodist, and joined by Drew Carey, MD, from Johns Hopkins University—explores whether atrophic optic nerves can exhibit swelling or thickening in patients with recurrent papilledema. Carey explains that papilledema can be due to various conditions, including idiopathic intracranial hypertension, hydrocephalus, or brain tumors, and that recurrent headaches may indicate increased pressure. A retrospective study¹ of 165 patients with papilledema found that 63% experienced at least one relapse, with 50% showing recurrent papilledema. OCT scans were crucial in detecting these relapses, even in atrophic nerves, suggesting that OCT remains a valuable tool in monitoring neurological conditions. Carey stresses the importance of OCT in detecting intracranial pressure changes in atrophic nerves, contrasting it with glaucoma management. The episode concludes with a proposed revised adage: “A dead nerve can't swell, but it can thicken.”

Reference

1. Xie JS, Donaldson L, Margolin EA. Swelling of atrophic optic discs in idiopathic intracranial hypertension. J Neuroophthalmol. 2024;44(2):212-218. doi:10.1097/WNO.0000000000001932