idiopathic intracranial hypertension (aka pseudotumor cerebri)

31 Jan

QUICK REVIEW:

SYMPTOMS:

  • Headache (92 percent)
  • Transient visual obscurations (72 percent)
  • Intracranial noises (pulsatile tinnitus) (60 percent)
  • Photopsia (54 percent) — flashes of light perception
  • Retrobulbar pain (44 percent)
  • Diplopia (38 percent)
  • Sustained visual loss (26 percent)

 

DIAGNOSIS:

mostly common sense

  • signs/symptoms increased ICP
  • normal neuro exam, no altered LOC
  • elevated ICP/opening pressure
  • normal cerebrospinal fluid (CSF) composition
  • neuroimaging negative
  • No other apparent cause

 

NORMAL OPENING PRESSURE:

  • upper limit of normal in adults is 200 mmH2O.  (=20 cmH2O)
  • Some believe that obese patients may have a higher upper limit of normal, ~250 mmH2O

 

WHY IS IIH/PSEUDOTUMOR BAD?

  • Permanent vision loss is the major morbidity associated with IIH.

 

TREATMENT OPTIONS:

  • carbonic anhydrase inhibitors,
  • loop diuretics,
  • corticosteroids.   
  • low-sodium weight reduction program
  • last resort–surgical intervention.

 

Submitted by Heather Reed-Day.

 

References: uptodate.com: Idiopathic intracranial hypertension (pseudotumor cerebri): Clinical features and diagnosis; picture

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