Pseudotumor Cerebri Idiopathic Intracranial Hypertension

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