Difference between revisions of "Idiopathic intracranial hypertension"

(Differential Diagnosis)
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==Differential Diagnosis==
 
==Differential Diagnosis==
 
*Aneurysm rupture and [[Subarachnoid Hemorrhage]]
 
*Aneurysm rupture and [[Subarachnoid Hemorrhage]]
*Brain tumor
+
*[[Brain tumor]]
 
*[[Encephalitis]]
 
*[[Encephalitis]]
 
*[[Head Injury]]
 
*[[Head Injury]]

Revision as of 04:55, 12 September 2016

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

Differential Diagnosis

Evaluation

  • Young, obese women
  • Headache (worse in AM / with manuvers increasing ICP)
  • Papilledema (optic atrophy/vision loss)
  • Neuro Exam frequently normal
    • May have cranial nerve palsies in severe, most often CN 6

Work-Up

  • CT scan (negative or slit-like ventricles)
  • LP (Opening pressure >25)
  • 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

External Links

See Also

References