title: Twin and triple peaks papilledema.
abstract: OBJECTIVE
  To describe 2 adult patients who presented with papilledema after band atrophy (i.e., twin and triple peaks papilledema).
  
  
  METHODS
  Retrospective small case series.
  
  
  METHODS
  Two outpatients.
  
  
  METHODS
  Observations made on 2 patients whose cases were reviewed in the neuro-ophthalmology clinic.
  
  
  RESULTS
  The first patient had a pituitary tumor presenting with papilledema, causing a triple peaks clinical sign. Color photographs, optical coherence tomograms, and magnetic resonance images are shown. The second patient developed twin peaks papilledema due to a chiasmal glioma causing secondary raised intracranial pressure.
  
  
  CONCLUSIONS
  Twin peaks papilledema is a rare clinical sign that may develop in adults as well as in children. The first report and optical coherence tomography features of triple peaks papilledema illustrate a new clinical sign.
authors.affiliation: Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom. jodmehta@gmail.com
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
authors.forename: Gordon T
authors.initials: GT
authors.lastname: Plant
authors.forename: James F
authors.initials: JF
authors.lastname: Acheson
mesh_terms: D000328:Adult; D005260:Female; D005910:Glioma / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D019586:Intracranial Hypertension; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009897:Optic Chiasm / Q000473:pathology*; D019574:Optic Nerve Neoplasms / Q000150:complications* / Q000175:diagnosis; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis; D015175:Prolactinoma / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence