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Idiopathic intracranial hypertension (IIH)

Overview

Idiopathic intracranial hypertension (referred to as benign intracranial hypertension, pseudotumor cerebri) is typically seen in middle-aged obese females. It is precipitated by hormonal therapies, PCOS, excessive vitamin A intake or some medications like tetracyclines.

Caused due to raised cerebrospinal fluid pressure.

  • Early morning headache that worsens on lying down
  • Blurring of vision
  • Double vision
  • Ringing of ears
  • Nausea and vomiting
  • Occasional confusion, disorientation

Neurologist

  • CSF manometry to check CSF pressure. Value above 18 cm of water is suggestive of IIH
  • Fundus examination may show papilloedema
  • MRI brain may show flattening of optic nerve head, empty sella, tortuosity of optic nerve

  • Medications to reduce CSF formation and pressure
  • CSF drainage
  • Ventriculoperitoneal shunt in medication refractory cases
  • Stenting of venous sinuses if venous sinus thrombosis is the cause of increased CSF pressure
  • Optic nerve fenestration of excessive CSF pressure around optic nerve is causing vision loss
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