Idiopathic intracranial hypertension: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Tends to occur in young, obese women | |||
*[[Headache]] | *[[Headache]] | ||
**Tend to be worse at night or first thing in the morning | **Tend to be worse at night or first thing in the morning | ||
**Frequently starts as dull occipital pain, may become diffuse and throbbing | **Frequently starts as dull occipital pain, may become diffuse and throbbing | ||
**Typically worse with maneuvers to increase ICP | |||
*[[Nausea and Vomiting]] | *[[Nausea and Vomiting]] | ||
*Vision blurring | *[[blurred vision|Vision blurring]] | ||
*[[Papilledema]] | |||
**can be visualized with [[Ocular ultrasound|ultrasound]] | |||
*Irregular menses or amenorrhea | *Irregular menses or amenorrhea | ||
*[[Neuro exam]] often normal | |||
**May have [[cranial nerve palsies]] if severe, most often [[abducens nerve palsy]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Headache DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*[[head CT|CT]] (negative or slit-like ventricles) | |||
*[[ | |||
*[[LP]] (Opening pressure >25) | *[[LP]] (Opening pressure >25) | ||
**CSF lab studies by [[lumbar puncture]] are negative | **CSF lab studies by [[lumbar puncture]] are negative | ||
Revision as of 03:24, 3 October 2019
Background
- Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)
- Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi
- Associated with OCPs, vitamin A, tetracycline and thyroid disorders
Clinical Features
- Tends to occur in young, obese women
- Headache
- Tend to be worse at night or first thing in the morning
- Frequently starts as dull occipital pain, may become diffuse and throbbing
- Typically worse with maneuvers to increase ICP
- Nausea and Vomiting
- Vision blurring
- Papilledema
- can be visualized with ultrasound
- Irregular menses or amenorrhea
- Neuro exam often normal
- May have cranial nerve palsies if severe, most often abducens nerve palsy
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
- CT (negative or slit-like ventricles)
- LP (Opening pressure >25)
- CSF lab studies by lumbar puncture are negative
- No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc
- CT or MR venogram (to rule out cerebral venous sinus thrombosis)
Management
- Repeat LPs (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
- Acetazolamide 500mg BID (decrease CSF production)
- Furosemide 20mg PO BID, give potassium supp as needed
- Weight loss
- CSF Shunt
- Optic nerve sheath fenestration
Disposition
- Admit for:
- Severe pain
- Focal findings
- Vision changes
- Otherwise, discharge with ophtho follow up for formal visual field monitoring