Assessment of Optic Disc Swelling (Papilledema) in Patients with Raised Intracranial Pressure and its Correlation with Neurological Findings: A Cross-Sectional Study

Objective: To determine the frequency of papilledema among patients with raised intracranial pressure by using the Frisén grading scale. Materials & Methods: A cross-sectional study was conducted among 198 adult patients with suspected or documented raised intracranial pressure at the University of Lahore Teaching Hospital, Lahore, Pakistan, from March to August 2026. Demographic, clinical, neurological, ophthalmological, and neuroimaging data were collected using a structured proforma. Papilledema was graded using the Frisén scale (Grades 0–5), with fundus photography and OCT used when available. Data were analyzed using IBM SPSS Statistics version 27. Descriptive statistics, chi-square or Fisher’s exact tests, Spearman’s correlation, and multivariable logistic regression were used as appropriate. Statistical significance was set at p less than 0.05, with 95% confidence intervals reported where applicable. Ethical approval, informed consent, and patient confidentiality were maintained. Results: Among 198 patients, the largest age group was 31–45 years (36.4%), with a slight male predominance (54.5%). Papilledema was present in 136 (68.7%) patients, with Grade 2 being the most frequent. Headache was the predominant symptom (81.3%), followed by nausea or vomiting (57.1%) and blurred vision (50.0%). Motor weakness (28.3%) and sixth cranial nerve palsy (26.8%) were the most common neurological abnormalities. Serious neurological findings were more frequent among patients with higher papilledema grades (85.5%) than those with lower grades (36.4%). ROC analysis showed better discrimination for Frisén grading (AUC = 0.762) than for papilledema presence or absence alone (AUC = 0.654), suggesting that grading severity may provide additional clinical information about neurological involvement. Conclusion: Papilledema was present in 68.7% of patients with raised intracranial pressure. Higher Frisén grades were associated with more frequent neurological abnormalities. Frisén grading demonstrated better discrimination of neurological outcomes than papilledema presence alone, highlighting its value in comprehensive clinical assessment.