Blood Pressure and the Brain Flashcards
Most cases of idiopathic intracranial hypertension are seen in which sex? These individuals are almost always what?
Female / obese
What are some conditions that may be associated with idiopathic intracranial hypertension?
Sleep apnoea, Addison’s disease, hypothyroidism, SLE
What are some medications that may be associated with idiopathic intracranial hypertension?
Antibiotics, hormones, lithium, vitamin A, steroid withdrawal
What are the two main presenting complaints of someone with idiopathic intracranial hypertension?
Headaches and visual losses
You should intervene in idiopathic intracranial hypertension when the only visual problem is what? This is to avoid progression to what?
Visual field defects / avoid progression to decreased visual acuity
What investigations should be done for idiopathic intracranial hypertension?
LP, CT/MRI
What will an LP of someone with idiopathic intracranial hypertension show with regards to a) pressure and b) CSF cytology?
a) raised pressure (>25cmCSF) b) normal
What will idiopathic intracranial hypertension show on CT/MRI?
Nothing, these will be normal
What is a condition that can present similarly to idiopathic intracranial hypertension and should be ruled out with imaging?
Venous sinus thrombosis
What are the single best treatments for idiopathic intracranial hypertension?
Weight loss (and treatment of underlying disorder if there is one)
If weight loss is unachievable, what are some other treatment options for idiopathic intracranial hypertension?
Shunts (LP/VP), repeated lumbar punctures, diuretics
What is the natural history of idiopathic intracranial hypertension?
A tendency to spontaneous resolution but a lifetime predisposition to raised pressure
What is the most common cause of spontaneous intracranial hypotension?
A spinal fluid leak
What is spontaneous intracranial hypotension?
The fluid pressure inside the skull is lower than normal
What is a common cause of intracranial hypotension which is not spontaneous?
Leak in the dura, causing CSF to drain quicker than normal
What is the principle symptom of spontaneous intracranial hypotension? What makes this worse?
Severe low pressure headache - worse on standing
Aside from the headache, what are some other features of spontaneous intracranial hypotension?
Neck/arm pain, diplopia, dizziness, muffled hearing, galactorrhoea, impaired sphincter control
What are some causes of spontaneous intracranial hypotension?
Idiopathic, collagen disorders, dural diverticula, trauma
What are some investigations that could be done for spontaneous intracranial hypotension?
MRI (head and spine), CT myelography, LP
What are you looking for on MRI of spontaneous intracranial hypotension?
Meningeal enhancement, chronic subdural haematomas, hindbrain herniations
What are you looking for on LP of spontaneous intracranial hypotension?
Low pressure
What are the first line treatments for spontaneous intracranial hypotension?
Bed rest, fluids and analgesics
If conservative treatment for spontaneous intracranial hypotension fails, what is another option?
Epidural blood patch: the patients blood is inserted into the dural sac (can patch up the defect before it heals on its own)
