All are seen in papilledema after a head injury except :
**Core Concept**
Papilledema is a condition characterized by swelling of the optic disc due to increased intracranial pressure (ICP). This can occur after a head injury, where trauma leads to a rise in ICP. The optic disc is the part of the eye responsible for transmitting visual information to the brain.
**Why the Correct Answer is Right**
In papilledema after a head injury, several changes can be observed on fundoscopic examination. These include:
* Blurring of the optic disc margins
* Swelling of the optic disc
* Retinal hemorrhages
* Cotton wool spots
* Afferent pupillary defect
The correct answer is a feature that is **not** typically seen in papilledema after a head injury.
**Why Each Wrong Option is Incorrect**
- **Option A:** Swelling of the optic disc is a hallmark of papilledema. This is due to the accumulation of fluid in the optic nerve head, leading to its swelling.
- **Option B:** Cotton wool spots are a common finding in papilledema. These are small, fluffy white lesions seen on the retina, resulting from retinal nerve fiber layer infarction.
- **Option C:** Retinal hemorrhages are another common feature of papilledema. These occur due to the increased pressure on the retinal vessels, leading to their rupture and bleeding.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that papilledema can be a sign of increased intracranial pressure, which can be due to various causes including head injury, tumors, or hemorrhages.
**Correct Answer:** D.