Idiopathic intracranial hypertension: Difference between revisions
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*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]] | ||
# | #[[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 | #[[Neuro Exam]] frequently normal | ||
==DDX== | ==DDX== | ||
#Aneurysm rupture and | #Aneurysm rupture and [[Subarachnoid Hemorrhage]] | ||
#Brain tumor | #Brain tumor | ||
#Encephalitis | #[[Encephalitis]] | ||
#Head | #[[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 | #[[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
- 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)
- 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