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Spontaneous venous pulsation (SVP) of the optic disc can be used as a surrogate marker of intracranial pressure (ICP) in patients with discs of normal morphology. The presence of SVP can suggest an ICP within normal limits.1 Based on this premise, SVP is also referred to when differentiating anomalous pseudopapilledematous optic nerves from true papilledema. However, this application may be limited by the fact that anomalous discs are less likely to demonstrate SVP.2 The case detailed below supports this contention.A 48-year-old white woman presented to our hospital complaining of a recent onset of blurred vision. She was known to have migraine with aura and had a past ocular history of unilateral disc drusen (left eye only). On examination, the best-corrected visual acuity was 0.7 in the right and 0.5 in the left. Anterior segment examination was unremarkable in both eyes. Color vision was normal in the right and slightly reduced in the left (10/13 Ishihara) and there was a left relative afferent pupillary defect. Funduscopy revealed left optic nerve drusen with a clearly …

Pearls & Oy-sters: Spontaneous venous pulsation and its role in differentiating papilledema from pseudopapilledema