Pseudotumor Cerebri Idiopathic Intracranial Hypertension

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Pseudotumor Cerebri Idiopathic Intracranial Hypertension

  1. 1. Idiopathic intracranial Hypertension <ul><li>Pseudotumor Cerebri </li></ul><ul><li>Benign Intracranial Hypertension </li></ul>AskTheNeurologist.Com Author Anon
  2. 2. Definition <ul><li>Clinical features of raised intracranial pressure (ICP) </li></ul><ul><li>Absence of space-occupying lesion (SOL) on brain imaging </li></ul><ul><li>Exclusion of other causes </li></ul>
  3. 3. Physiology of raised ICP
  4. 4. Epidemiology <ul><li>General population = 1 / 100,000 / yr </li></ul><ul><li>Women aged 15 – 44 = 3.5 / 100,000 / yr </li></ul><ul><li>Women BMI >29 = 20 / 100,000 / yr </li></ul>
  5. 5. Clinical features of Idiopathic Intracranial Hypertension <ul><li>Headache </li></ul><ul><li>Vomiting </li></ul><ul><li>Visual symptoms / signs </li></ul><ul><ul><li>Transient visual obscurations </li></ul></ul><ul><ul><li>Diplopia (VIth Nerve palsy) </li></ul></ul><ul><ul><ul><li>“ false localising sign” </li></ul></ul></ul><ul><ul><li>Enlarged blind-spot </li></ul></ul><ul><li>Papilledema on fundus examination </li></ul><ul><li>Rest of neurological examination should be normal </li></ul>
  6. 6. Identifying papilledema Normal Papilledema
  7. 7. Conditions to Exclude <ul><li>SOL </li></ul><ul><li>Hydrocephalus </li></ul><ul><li>Venous Sinus Thrombosis </li></ul><ul><li>Chronic Meningitis </li></ul><ul><ul><ul><li>Infective </li></ul></ul></ul><ul><ul><ul><li>Inflammatory / granulomatous </li></ul></ul></ul><ul><ul><ul><li>Neoplastic (Carcinomatous / lymphomatous) </li></ul></ul></ul><ul><li>“ Medical causes” </li></ul><ul><ul><li>CO 2 retention </li></ul></ul><ul><ul><li>Malignant hypertension </li></ul></ul>
  8. 8. How do we make the diagnosis? <ul><li>Clinical features of raised ICP without apparent cause </li></ul><ul><li>Normal brain imaging </li></ul><ul><li>Normal imaging of venous system </li></ul><ul><li>LP (serves 3 purposes): </li></ul><ul><ul><li>Checks pressure – establishes diagnosis </li></ul></ul><ul><ul><li>CSF analysis – excludes infectious, inflammatory and neoplastic etiologies </li></ul></ul><ul><ul><li>Symptomatic improvement </li></ul></ul>
  9. 9. Associated Factors <ul><li>Female > Male </li></ul><ul><li>Obesity </li></ul><ul><li>Drugs </li></ul><ul><ul><li>Tetracyclines </li></ul></ul><ul><ul><li>Vitamin A </li></ul></ul><ul><li>Iron Deficiency Anemia </li></ul><ul><li>Endocrine abnormalities </li></ul><ul><ul><li>Hypothyroidism </li></ul></ul><ul><ul><li>Hypoparathyroidism </li></ul></ul><ul><ul><li>PCOS (probably independent of obesity, acne treatment) </li></ul></ul>
  10. 10. Treatment <ul><li>Treat risk factors </li></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Correct endocrine abnormalities </li></ul></ul><ul><ul><li>Stop offending medication </li></ul></ul><ul><li>Medical ( decrease CSF production) </li></ul><ul><ul><li>Carbonic anhydrase inhibitors </li></ul></ul><ul><ul><li>Furosemide </li></ul></ul><ul><li>Surgical </li></ul><ul><ul><li>CSF diversion procedures </li></ul></ul><ul><ul><li>Optic nerve sheath fenestration </li></ul></ul>
  11. 11. “ Benign Intracranial Hypertension?” - No longer! <ul><li>May lead to irreversible visual loss </li></ul>Normal Optic atrophy
  12. 12. Follow up <ul><li>Symptoms of raised ICP </li></ul><ul><li>Neuro-opthalmological assessment </li></ul><ul><ul><ul><li>Visual Field Testing </li></ul></ul></ul><ul><ul><ul><li>Fundus Examination </li></ul></ul></ul>
  13. 13. Thanks for your Attention! AskTheNeurologist.Com

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