Difference between revisions of "Idiopathic intracranial hypertension"
| Line 38: | Line 38: | ||
#Repeat [[LP]]s (decrease CSF pressure) | #Repeat [[LP]]s (decrease CSF pressure) | ||
#[[Acetazolamide]] 500mg BID (decrease CSF production) | #[[Acetazolamide]] 500mg BID (decrease CSF production) | ||
| + | #[[Furosemide]] 20 mg PO BID, give potassium supp as needed | ||
#Weight loss | #Weight loss | ||
#CSF Shunt | #CSF Shunt | ||
Revision as of 14:42, 15 October 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 sinus 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
Differential Diagnosis
- 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 (decrease CSF production)
- Furosemide 20 mg 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 w/ ophtho f/u for formal visual field monitoring
Source
Tintinalli