Difference between revisions of "Idiopathic intracranial hypertension"

(Clinical Features)
Line 5: Line 5:
  
 
==Clinical Features==
 
==Clinical Features==
 +
*Tends to occur in young, obese women
 
*[[Headache]]
 
*[[Headache]]
 
**Tend to be worse at night or first thing in the morning
 
**Tend to be worse at night or first thing in the morning
 
**Frequently starts as dull occipital pain, may become diffuse and throbbing
 
**Frequently starts as dull occipital pain, may become diffuse and throbbing
 +
**Typically worse with maneuvers to increase ICP
 
*[[Nausea and Vomiting]]
 
*[[Nausea and Vomiting]]
*Vision blurring
+
*[[blurred vision|Vision blurring]]
 +
*[[Papilledema]]
 +
**can be visualized with [[Ocular ultrasound|ultrasound]]
 
*Irregular menses or amenorrhea
 
*Irregular menses or amenorrhea
 +
*[[Neuro exam]] often normal
 +
**May have [[cranial nerve palsies]] if severe, most often [[abducens nerve palsy]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*Aneurysm rupture and [[Subarachnoid Hemorrhage]]
+
{{Headache DDX}}
*[[Brain tumor]]
 
*[[Encephalitis]]
 
*[[Head Injury]]
 
*Hydrocephalus (increased CSF)
 
*Hypertensive brain hemorrhage
 
*Intraventricular hemorrhage
 
*[[Cerebral venous sinus thrombosis]]
 
*[[Meningitis]]
 
*[[Subdural Hematoma]]
 
*[[Status epilepticus]]
 
*[[Stroke]]
 
  
 
==Evaluation==
 
==Evaluation==
*Young, obese women
+
*[[head CT|CT]] (negative or slit-like ventricles)
*[[Headache]] (worse in AM / with manuvers increasing ICP)
 
*Papilledema (optic atrophy/vision loss)
 
**can be visualized with [[Ocular ultrasound|ultrasound]]
 
*[[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)
 
*[[LP]] (Opening pressure >25)
 
**CSF lab studies by [[lumbar puncture]] are negative
 
**CSF lab studies by [[lumbar puncture]] are negative

Revision as of 03:24, 3 October 2019

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

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Evaluation

  • CT (negative or slit-like ventricles)
  • LP (Opening pressure >25)
    • CSF lab studies by lumbar puncture are negative
    • No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc
  • CT or 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