BACKGROUND: Heidelberg Retina Tomograph is a scanning laser ophthalmoscope that is routinely used for the assessment and serial measurement of optic nerve morphology and nerve fiber layer anatomy in the setting of elevated intraocular pressure typically encountered in glaucoma. Recent studies have explored the use of this device in the objective assessment of optic nerve head swelling occurring in the setting of elevated intracranial pressure, also known as papilledema. We explore the utility of HRT as a complementary evaluation to serial fundoscopic examination of the optic nerve head in a patient with a high-grade SAH, raised intracranial pressure, and papilledema secondary to rupture of a giant intracranial aneurysm. To our knowledge, this represents the first report of the use of this technology as an objective assessment of papilledema in the setting of SAH.

CASE DESCRIPTION: A 23-year-old man presented with spontaneous SAH secondary to a ruptured giant internal carotid artery aneurysm. The patient underwent endovascular embolization to prevent further hemorrhage and was monitored with HRT on a monthly basis. Severe papilledema, present at the outset and confirmed by the neuro-ophthalmologic consultant, was followed by serial examination with the device.

CONCLUSION: Heidelberg Retina Tomograph is a promising device for the analysis of optic nerve head topography in the setting of papilledema in SAH. Worsening or resolution of papilledema can be qualitatively demonstrated with serial studies using this device.