Idiopathic intracranial hypertension

Revision as of 04:13, 22 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "0 mg" to "0mg")

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

  1. Headache
  2. Nausea and Vomiting
  3. Vision blurring

Differential Diagnosis

Evaluation

  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

Work-Up

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

Management

  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 20mg PO BID, give potassium supp as needed
  4. Weight loss
  5. CSF Shunt
  6. 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