Papilledema is a swollen nerve due to elevated intracranial pressure. It is one of the features of IIH and papilledema is important particularly because it could lead to vision loss.
We use a simple grading scale depending on how blurry the nerve looks.
(The nerve can also be called the disc.)
It is a 6 point scale
Grade 0 means normal- no papilledema
Grade 1-2 is considered low grade and does not often cause vision loss.
Grade 3-5 is high grade and the risk of vision loss goes up. Grade 5 is particularly high and only very rare.
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| Grade 0 |
0: This is a normal optic nerve. Notice that the disc margins are nice and distinct, no blurriness here.
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| Grade 1 |
1: We start to see blurriness on one side of the nerve. (It is always the side closest to the nose.)
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| Grade 3 |
3: At this stage, the blurring is severe enough that it seems to obscure the blood vessels as they cross over the edge of the disc. Of course the blood vessel is still there, but if it looks like it disappears that is grade 3.
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| Grade 4 |
4: At this point the blurriness is severe enough that it obscures some of the blood vessels even in the middle of the disc. (Also note that there are a lot of hemorrhages around the disc. This is not part of the grading system but does give you a clue that this is more acute and more severe.)
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| Grade 5 |
5: With grade 5 edema, the nerve is so swollen that all the normal features are obscured. You can't really see any of the blood vessels or anything else.
Here is the side by side summary image of papilledema grades:
