A 12-year-old boy is found to have bilateral optic disc elevation on routine examination. Visual acuity is 6/6 bilaterally with normal colour vision and no blind spot enlargement. Disc margins appear lumpy and irregular with no venous engorgement or haemorrhages. Which investigation best confirms the diagnosis?

• A MRI brain with contrast
• B Fluorescein angiography showing leakage
• C Lumbar puncture with opening pressure
• D B-scan ultrasonography showing calcification ✓

Explanation

Optic disc drusen are calcified hyaline bodies within the nerve head causing pseudopapilloedema. D-scan ultrasonography demonstrates calcification with high sensitivity. The lumpy disc without venous engorgement or haemorrhages distinguishes drusen from true papilloedema. MRI is unnecessary. Lumbar puncture would be normal. Fluorescein angiography in drusen shows autofluorescence without leakage, unlike true papilloedema which shows late leakage.

Reference: AAO: Neuro-Ophthalmology, 2022 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.