Idiopathic intracranial hypertension
Background
- Also known as pseudotumor cerebri
- May be due to impaired arachnoid villi absorption
- Associated with OCPs, vitamin A, tetracycline, and thyroid disorders
Work-Up
- CT scan (negative)
- LP (Opening pressure >25)
Clinical Features
- Headache
- Nausea and Vomiting
- Vision blurring
Diagnosis
- Young, obese women
- Headache (worse in AM / with manuvers increasing ICP)
- Papilledema (optic atrophy/vision loss)
- can be visualized with ultrasound
- Neuro Exam frequently normal
DDX
- Aneurysm rupture and Subarachnoid Hemorrhage
- Brain tumor
- Encephalitis
- Head Injury
- Hydrocephalus (increased fluid around the brain)
- Hypertensive brain hemorrhage
- Intraventricular hemorrhage
- Meningitis
- Subdural Hematoma
- Status epilepticus
- Stroke
Treatment
- Repeat LPs (decrease CSF pressure)
- Acetazolamide 500mg BID
- Weight loss
- CSF Shunt
- 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