Difference between revisions of "Idiopathic intracranial hypertension"

(Text replacement - "0 mg" to "0mg")
Line 5: Line 5:
  
 
==Clinical Features==
 
==Clinical Features==
#[[Headache]]
+
*[[Headache]]
#[[Nausea and Vomiting]]
+
*[[Nausea and Vomiting]]
#Vision blurring
+
*Vision blurring
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
Line 24: Line 24:
  
 
==Evaluation==
 
==Evaluation==
#Young, obese women
+
*Young, obese women
#[[Headache]] (worse in AM / with manuvers increasing ICP)
+
*[[Headache]] (worse in AM / with manuvers increasing ICP)
#Papilledema (optic atrophy/vision loss)
+
*Papilledema (optic atrophy/vision loss)
##can be visualized with [[Ocular ultrasound|ultrasound]]
+
**can be visualized with [[Ocular ultrasound|ultrasound]]
#[[Neuro Exam]] frequently normal
+
*[[Neuro Exam]] frequently normal
##May have cranial nerve palsies in severe, most often CN 6
+
**May have cranial nerve palsies in severe, most often CN 6
  
 
===Work-Up===
 
===Work-Up===
#CT scan (negative or slit-like ventricles)
+
*CT scan (negative or slit-like ventricles)
#[[LP]] (Opening pressure >25)
+
*[[LP]] (Opening pressure >25)
#MR venogram (to r/o cerebral venous sinus thrombosis)
+
*MR venogram (to r/o cerebral venous sinus thrombosis)
  
 
==Management==
 
==Management==
#Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
+
*Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
#[[Acetazolamide]] 500mg BID (decrease CSF production)
+
*[[Acetazolamide]] 500mg BID (decrease CSF production)
#[[Furosemide]] 20mg PO BID, give potassium supp as needed
+
*[[Furosemide]] 20mg PO BID, give potassium supp as needed
#Weight loss
+
*Weight loss
#CSF Shunt
+
*CSF Shunt
#Optic nerve sheath fenestration
+
*Optic nerve sheath fenestration
  
 
==Disposition==
 
==Disposition==

Revision as of 12:11, 28 July 2016

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

Clinical Features

Differential Diagnosis

Evaluation

  • Young, obese women
  • Headache (worse in AM / with manuvers increasing ICP)
  • Papilledema (optic atrophy/vision loss)
  • Neuro Exam frequently normal
    • May have cranial nerve palsies in severe, most often CN 6

Work-Up

  • CT scan (negative or slit-like ventricles)
  • LP (Opening pressure >25)
  • MR venogram (to r/o cerebral venous sinus thrombosis)

Management

  • Repeat LPs (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
  • Acetazolamide 500mg BID (decrease CSF production)
  • Furosemide 20mg 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 with ophtho follow up for formal visual field monitoring

External Links

Induction to EM: An approach to headache in the ED. St.Emlyn’s

See Also

Ocular ultrasound

References