Difference between revisions of "Idiopathic intracranial hypertension"

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Revision as of 14:14, 22 March 2016


  • 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


  1. CT scan (negative or slit-like ventricles)
  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


  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
    1. May have cranial nerve palsies in severe, most often CN 6

Differential Diagnosis


  1. Repeat LPs (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
  2. Acetazolamide 500mg BID (decrease CSF production)
  3. Furosemide 20 mg PO BID, give potassium supp as needed
  4. Weight loss
  5. CSF Shunt
  6. Optic nerve sheath fenestration


  • Admit for:
    • Severe pain
    • Focal findings
    • Vision changes
  • Otherwise, discharge w/ ophtho f/u for formal visual field monitoring