Benign Intracranial Hypertension Flashcards
What is benign intracranial hypertension
A syndrome of increased intracranial pressure without hydrocephalus or mass lesion
Who is most likely to get benign intracranial hypertension
Young, overweight women
Also associated with the OCP
How would this patient present
Daily headache w. nausea and vomiting Transient visual obscurations (loss of vision) Diplopia - due to sixth nerve palsy Papilloedema Low pitched tinnitus
What else can causes optic disc swelling apart from papilloedema (ie. not due to raised ICP)
Optic neuritis
Ischaemia
Neoplastic infiltration
What are some causes of raised ICP
Space occupying lesions - tumours, abscess
Haemorrhage - subdural, subarachnoid
Infection - meningitis, encephalitis
Benign intracranial hypertension
What investigations should be done for Benign intracranial hypertension
MRI - rule out other causes of raised ICP, confirm raised ICP
Lumbar puncture - opening pressure >250 = BIH
What are radiological signs of raised ICP
Flattening of the posterior globe (80%) Empty sella (70%) - flattening of the pituitary gland due to raised ICP
What is the normal CSF opening pressure
What is the conservative management of benign intracranial hypertension
Weight loss
Stop drugs which may have causative effect - OCP
What is the medical management of benign intracranial hypertension
Acetazolamide
Loop diuretic - furosemide
Headache can be treated with amitryptilline
How does Acetazolamide work to reduce ICP
It reduces the rate of CSF production by the choroid plexus
What is the surgical management of benign intracranial hypertension
Repeated LP
If visual loss
- Optic nerve sheath fenestration
- Ventriculoperitoneal shunt
What is a complication of benign intracranial hypertension
Permanent and significant visual loss - occurs in 10%
