Going to College or University with Intracranial Hypertension


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Sometimes called Benign Intracranial Hypertension, Idiopathic Intracranial Hypertension or Pseudotumour Cerebri is a rare condition which occurs in about 1 or 2 in 100,000 people. In children, boys and girls are affected equally, but if the onset is in adult life, the majority of cases are seen in women.

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Going to College or University with Intracranial Hypertension

  1. 1. shinecharity.org.uk info@shinecharity.org.uk 42 Park Road Peterborough PE1 2UQ 01733 555988Going to College or University withIntracranial HypertensionSometimes called Benign Intracranial Hypertension, IdiopathicIntracranial Hypertension or Pseudotumour Cerebri is a rarecondition which occurs in about 1 or 2 in 100,000 people. Inchildren, boys and girls are affected equally, but if the onsetis in adult life, the majority of cases are seen in women.Onset can be sudden or insidious; examined, papilloedema (swellingthe cause is not known, but of the disc) is seen: the youngalways present are:- person should then be referred urgently to a neurologist.a) an abnormality in absorptionor excess production of Other symptoms includecerebrospinal fluid (CSF) leading headaches (often debilitating,to a build-up of this fluid in the often misdiagnosed as migraine),brain; nausea or vomiting, problems with balance and spatial awareness,b) increased blood volume in the dizziness, short term memory lossvessels around the brain; and changed behaviour. These symptoms are due to an increasec) swelling of the brain in intracranial pressure (ICP = pressure inside the head).IH is often diagnosed after sightproblems lead to an appointment Students with raised ICP may findwith the optician. When the optic it difficult to cope with previouslydiscs (back of the eyes) are managed tasks and may appear to
  2. 2. Going to College or University withIntracranial Hypertension“lose” information previously learnt. to another catheter which drains into the abdomenSome students may leak CSFdown the nose. In practice, the young person may undergo frequent shunt revision andTreatment may need a ventricular peritoneal shunt in addition to, or instead of,CT scan will exclude tumour. the LP Shunt.Between 11 - 35% of cases resolve The VP shunt has a catheter intospontaneously. the brain connected to a valve which is, in turn, connected to aThe first line of treatment is usually tube into the abdomenby diet (if very overweight) combinedwith drugs. In some cases, two It is impossible to predict whetherweeks treatment with steroids is a particular shunt will fail, or howsufficient to re-open thevenous often and for how long the studentpathways within the brain so that may be hospitalised as a result.the IH resolves. Even with a fully functioningOthers need repeated lumbar shunt, some people have severepunctures to remove excess CSF: headaches and may not manageafterwards the student may need a to attend college full time. Theyfew days out of college. should be encouraged to attend at the time of day when they feel wellSome people need the CSF and the time gradually increased. Indiverted by means of a surgically some students the headaches caninserted shunt. be so debilitating (and sometimes accompanied by vomiting) that timeIn theory, a lumbar peritoneal (LP) in college may be very limited. Inshunt is the shunt of choice. others, the pattern of incapacitating headaches can be very intermittentThe LP shunt has a catheter placed and therefore unpredictable. Wheninto the spine which is connected in college, there is little that the
  3. 3. shunts will prevent them from cause spatial problems which candoing. mean difficulties in using open tread staircases or escalators andThey can swim, take part in sports, in judging speed of traffic whenrun and jump. Someone with a crossing the road. ConcentrationLP shunt should not do stretching may be affected; short termor twisting exercises, nor should memory problems are commonhe/she somersault, take part in although long term memory isactivities such as bungee jumping usually unaffected.or go on the extreme rides at themeparks (eg Oblivion at Alton Towers It may be necessary to breakor any others with a negative instructions into single componentsG-force). and not overload the student. Support needs to be given toIf he/she has an injury to the back help the student develop copingor abdomen and becomes unwell, strategies. Care should be taken todamage to the shunt should be set realistic targets for the student,considered, although this is very especially in coursework. It is usefulrare. to remind them a week or so before coursework is due to be handedWith a VP shunt, care should be in and to allow extensions onlytaken not to “grab” the young if the student is ill, thus avoidingperson round the neck. So he/she the situation where they havewould be inadvised to take part in extensions from all tutors and ajudo, rugby scrums etc. mass of work to complete at once. Modular courses are arguablyCare should also be taken after better as they don’t rely on a singlea blow to the head or abdomen massive exam at the end of four(eg from a football): if the student years.does not recover, shunt damagemust be considered. Again, this is, Exams, as for all students, will befortunately, very rare. stressful. Special arrangements may be required for exams. TheyIntracranial Hypertension can may need a separate room so they
  4. 4. can move around (if treated with LP part of student social life involvesshunt) or have a drink (especially in alcohol:-summer term exams). People with shunts need to matchFriendships are very important for their alcohol intake with water;students with IH as their natural avoiding the dehydration which caninclination is often to be “loners”, cause the “hangover” headache soso every effort must be taken to easily confused with the “novel”encourage friendships already headache of raised ICP.made and appropriate newfriendships. This is essential if the They may also have difficulty in bodystudent misses a lot of college or temperature control, so on very hotis only attending for part of the day. days should be encouraged to stay in the shade when outside, and sitPeople with shunts may be prone in a cool part of the room whento dehydration in the heat (more indoors.so than their peers) so will needfrequent, even hourly drinks of For further information on IH, pleaseclear fluid (ie water) but not drinks see information sheet Intracranialcontaining caffeine. Hypertension, or contact Shine on 01733 555988 to speak to aIt must be acknowledged that specialist adviser.Help usShine relies on people’s generosity and support so we can help our clientswho depend on us for help and advice - people with hydrocephalus,spina bifida, their families and carers. To donate to Shine please visitwww.shinecharity.org.uk or call 01733 421329.This information has been produced by Shine’s medical advisers andapproved by Shine’s Medical Advisory Committee of senior medicalprofessionals.Shine - Registered charity no.249338To see our full range of information sheets and to find out how to donateto Shine please visit www.shinecharity.org.uk