Difference between revisions of "Idiopathic intracranial hypertension"
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#[[Encephalitis]] | #[[Encephalitis]] | ||
#[[Head Injury]] | #[[Head Injury]] | ||
| − | #Hydrocephalus (increased | + | #Hydrocephalus (increased CSF) |
#Hypertensive brain hemorrhage | #Hypertensive brain hemorrhage | ||
#Intraventricular hemorrhage | #Intraventricular hemorrhage | ||
| + | #Cerebral venous sinus thrombosis | ||
#[[Meningitis]] | #[[Meningitis]] | ||
#[[Subdural Hematoma]] | #[[Subdural Hematoma]] | ||
Revision as of 00:34, 9 February 2015
Contents
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
Work-Up
- CT scan (negative)
- LP (Opening pressure >25)
- MR venogram (to r/o cerebral venous thrombosis)
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 CSF)
- Hypertensive brain hemorrhage
- Intraventricular hemorrhage
- Cerebral venous sinus thrombosis
- 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