Idiopathic intracranial Hypertension

Posted On May 12, 2020

IIH is most commonly seen in obese woman of child bearing age.

Clinical features

• Persistent headache
• Blurred vision
• papilledema
• 6th nerve palsy
• otherwise normal neuro exam
• IIH without papilledema (IIHWOP)

Tests

• MRI head wo and w contrast
• MRV to check for venous thormbosis
• Lumbar puncture: opening pressure over 25 cm water, otherwise normal CSF
• Other tests:
  • Visual field testing
  • Ocular coherence tomography

Treatment

• Medication
  • Acetazolamide; start at 500 mg bid, max 4 g per day
  • Topiramate: 25 mg qd, tup to 100 mg bid
  • Furosemide: data limited
  • Octreotide: small case study
• Lose weight
• Surgical
  • LP
  • VP shunt
  • Optic nerve sheath fenestration

Headache

• comorbid migraine common
• Post LP, VP shunts, most has headache relief, but recurs in over 1/3 of patients at 3 year follow up
• Treat as migraine
• Migraine prevention

Further reading

• PracticalNeurology – Idiopathic Intracranial Hypertension