Pseudotumor Cerebri (Idiopathic intracranial hypertension)

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Pseudotumor Cerebri (Idiopathic intracranial hypertension).
Lecture for medical students and doctors regarding this syndrome of raised intracranial pressure which normally presents with headaches and visual symptoms especially in overweight individuals or those on acne medication.

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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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