Idiopathic intracranial hypertension

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

Work-Up

1. CT scan (negative)
2. LP (Opening pressure >25)

Clinical Features

1. Headache
2. Nausea and Vomiting
3. Vision blurring

Diagnosis

1. Young, obese women
2. Headache (worse in AM / with manuvers increasing ICP)
3. Papilledema (optic atrophy/vision loss)
   1. can be visualized with ultrasound
4. Neuro Exam frequently normal

DDX

1. Aneurysm rupture and Subarachnoid Hemorrhage
2. Brain tumor
3. Encephalitis
4. Head Injury
5. Hydrocephalus (increased fluid around the brain)
6. Hypertensive brain hemorrhage
7. Intraventricular hemorrhage
8. Meningitis
9. Subdural Hematoma
10. Status epilepticus
11. Stroke

Treatment

1. Repeat LPs (decrease CSF pressure)
2. Acetazolamide 500mg BID
3. Weight loss
4. CSF Shunt
5. Optic nerve sheath fenestration

Disposition

• Admit for:
  • Severe pain
  • Focal findings
  • Vision changes
• Otherwise, discharge w/ ophtho f/u for formal visual field monitoring

Source

Tintinalli