Difference between revisions of "Idiopathic intracranial hypertension"

Line 2: Line 2:
 
*Also known as pseudotumor cerebri
 
*Also known as pseudotumor cerebri
 
*May be due to impaired arachnoid villi absorption
 
*May be due to impaired arachnoid villi absorption
*Associated with OCPs, vitamin A, tetracycline, and thyroid disorders
+
*Associated with OCPs, vitamin A, [[tetracycline]], and thyroid disorders
  
 
==Work-Up==
 
==Work-Up==
 
#CT scan (negative)
 
#CT scan (negative)
#LP (Opening pressure >25)  
+
#[[LP]] (Opening pressure >25)  
  
 
==Clinical Features==
 
==Clinical Features==
#Headache
+
#[[Headache]]
#N/V
+
#[[Nausea and Vomiting]]
 
#Vision blurring
 
#Vision blurring
  
 
==Diagnosis==
 
==Diagnosis==
 
#Young, obese women
 
#Young, obese women
#Headache (worse in AM / with manuvers increasing ICP)
+
#[[Headache]] (worse in AM / with manuvers increasing ICP)
 
#Papilledema (optic atrophy/vision loss)
 
#Papilledema (optic atrophy/vision loss)
#Neuro exam frequently normal  
+
#[[Neuro Exam]] frequently normal  
  
 
==DDX==
 
==DDX==
#Aneurysm rupture and subarachnoid hemorrhage
+
#Aneurysm rupture and [[Subarachnoid Hemorrhage]]
 
#Brain tumor
 
#Brain tumor
#Encephalitis
+
#[[Encephalitis]]
#Head injury
+
#[[Head Injury]]
 
#Hydrocephalus (increased fluid around the brain)
 
#Hydrocephalus (increased fluid around the brain)
 
#Hypertensive brain hemorrhage
 
#Hypertensive brain hemorrhage
 
#Intraventricular hemorrhage
 
#Intraventricular hemorrhage
#Meningitis
+
#[[Meningitis]]
#Subdural hematoma
+
#[[Subdural Hematoma]]
 
#Status epilepticus
 
#Status epilepticus
#Stroke
+
#[[Stroke]]
  
 
==Treatment==
 
==Treatment==

Revision as of 15:34, 30 March 2014

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

  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)
  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