Difference between revisions of "Idiopathic intracranial hypertension"
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==Clinical Features== | ==Clinical Features== | ||
| − | + | *[[Headache]] | |
| − | + | *[[Nausea and Vomiting]] | |
| − | + | *Vision blurring | |
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 24: | Line 24: | ||
==Evaluation== | ==Evaluation== | ||
| − | + | *Young, obese women | |
| − | + | *[[Headache]] (worse in AM / with manuvers increasing ICP) | |
| − | + | *Papilledema (optic atrophy/vision loss) | |
| − | + | **can be visualized with [[Ocular ultrasound|ultrasound]] | |
| − | + | *[[Neuro Exam]] frequently normal | |
| − | + | **May have cranial nerve palsies in severe, most often CN 6 | |
===Work-Up=== | ===Work-Up=== | ||
| − | + | *CT scan (negative or slit-like ventricles) | |
| − | + | *[[LP]] (Opening pressure >25) | |
| − | + | *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 | |
| − | + | *[[Acetazolamide]] 500mg BID (decrease CSF production) | |
| − | + | *[[Furosemide]] 20mg PO BID, give potassium supp as needed | |
| − | + | *Weight loss | |
| − | + | *CSF Shunt | |
| − | + | *Optic nerve sheath fenestration | |
==Disposition== | ==Disposition== | ||
Revision as of 12:11, 28 July 2016
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
Clinical Features
- Headache
- Nausea and Vomiting
- Vision blurring
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
Evaluation
- 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
- 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