Difference between revisions of "Idiopathic intracranial hypertension"

(DDX)
(Differential Diagnosis)
Line 29: Line 29:
 
*Hypertensive brain hemorrhage
 
*Hypertensive brain hemorrhage
 
*Intraventricular hemorrhage
 
*Intraventricular hemorrhage
*Cerebral venous sinus thrombosis
+
*[[Cerebral venous sinus thrombosis]]
 
*[[Meningitis]]
 
*[[Meningitis]]
 
*[[Subdural Hematoma]]
 
*[[Subdural Hematoma]]
*Status epilepticus
+
*[[Status epilepticus]]
 
*[[Stroke]]
 
*[[Stroke]]
  

Revision as of 05:03, 9 February 2015

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

  1. CT scan (negative)
  2. LP (Opening pressure >25)
  3. MR venogram (to r/o cerebral venous sinus thrombosis)

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)
    1. can be visualized with ultrasound
  4. Neuro Exam frequently normal

Differential Diagnosis

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