Idiopathic Intracranial Hypertension

Background/Epidemiology

  • Incidence ~3/100,000
  • More common in obese, young women
  • Occurs in the absence of any identifiable underlying cause e.g. structural lesion, hydrocephalus
    • Cause not fully understood- ?problem with CSF reabsorption by arachnoid villi

Presentation

  • Headache
  • Diplopia or visual disturbance (most commonly ‘greying out’)
    • Often change with posture e.g. bending/straining
  • Papilloedema and 6th nerve palsy may be present

Investigations

  • Imaging to rule out other causes
    • Ventricles are usually normal
  • LP can reveal increased CSF pressure; alternatively ICP monitoring

Management

  • Management can be difficult.
    • Weight loss can be tried
    • Azetazolaminde/topiramate
    • Repeated LP
    • Surgery (optic nerve sheath fenestration or shunting)

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