Difference between revisions of "Idiopathic intracranial hypertension"

(Differential Diagnosis)
(Treatment)
Line 36: Line 36:
  
 
==Treatment==
 
==Treatment==
#Repeat LPs (decrease CSF pressure)
+
#Repeat [[LP]]s (decrease CSF pressure)
#Acetazolamide 500mg BID
+
#[[Acetazolamide]] 500mg BID
 
#Weight loss
 
#Weight loss
 
#CSF Shunt
 
#CSF Shunt
#Optic nerve sheath fenestration  
+
#Optic nerve sheath fenestration
  
 
==Disposition==
 
==Disposition==

Revision as of 15:39, 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