Blood Pressure and the Brain

Question 1

Most cases of idiopathic intracranial hypertension are seen in which sex? These individuals are almost always what?

Answer 1

Female / obese

Question 2

What are some conditions that may be associated with idiopathic intracranial hypertension?

Answer 2

Sleep apnoea, Addison’s disease, hypothyroidism, SLE

Question 3

What are some medications that may be associated with idiopathic intracranial hypertension?

Answer 3

Antibiotics, hormones, lithium, vitamin A, steroid withdrawal

Question 4

What are the two main presenting complaints of someone with idiopathic intracranial hypertension?

Answer 4

Headaches and visual losses

Question 5

You should intervene in idiopathic intracranial hypertension when the only visual problem is what? This is to avoid progression to what?

Answer 5

Visual field defects / avoid progression to decreased visual acuity

Question 6

What investigations should be done for idiopathic intracranial hypertension?

Answer 6

LP, CT/MRI

Question 7

What will an LP of someone with idiopathic intracranial hypertension show with regards to a) pressure and b) CSF cytology?

Answer 7

a) raised pressure (>25cmCSF) b) normal

Question 8

What will idiopathic intracranial hypertension show on CT/MRI?

Answer 8

Nothing, these will be normal

Question 9

What is a condition that can present similarly to idiopathic intracranial hypertension and should be ruled out with imaging?

Answer 9

Venous sinus thrombosis

Question 10

What are the single best treatments for idiopathic intracranial hypertension?

Answer 10

Weight loss (and treatment of underlying disorder if there is one)

Question 11

If weight loss is unachievable, what are some other treatment options for idiopathic intracranial hypertension?

Answer 11

Shunts (LP/VP), repeated lumbar punctures, diuretics

Question 12

What is the natural history of idiopathic intracranial hypertension?

Answer 12

A tendency to spontaneous resolution but a lifetime predisposition to raised pressure

Question 13

What is the most common cause of spontaneous intracranial hypotension?

Answer 13

A spinal fluid leak

Question 14

What is spontaneous intracranial hypotension?

Answer 14

The fluid pressure inside the skull is lower than normal

Question 15

What is a common cause of intracranial hypotension which is not spontaneous?

Answer 15

Leak in the dura, causing CSF to drain quicker than normal

Question 16

What is the principle symptom of spontaneous intracranial hypotension? What makes this worse?

Answer 16

Severe low pressure headache - worse on standing

Question 17

Aside from the headache, what are some other features of spontaneous intracranial hypotension?

Answer 17

Neck/arm pain, diplopia, dizziness, muffled hearing, galactorrhoea, impaired sphincter control

Question 18

What are some causes of spontaneous intracranial hypotension?

Answer 18

Idiopathic, collagen disorders, dural diverticula, trauma

Question 19

What are some investigations that could be done for spontaneous intracranial hypotension?

Answer 19

MRI (head and spine), CT myelography, LP

Question 20

What are you looking for on MRI of spontaneous intracranial hypotension?

Answer 20

Meningeal enhancement, chronic subdural haematomas, hindbrain herniations

Question 21

What are you looking for on LP of spontaneous intracranial hypotension?

Answer 21

Low pressure

Question 22

What are the first line treatments for spontaneous intracranial hypotension?

Answer 22

Bed rest, fluids and analgesics

Question 23

If conservative treatment for spontaneous intracranial hypotension fails, what is another option?

Answer 23

Epidural blood patch: the patients blood is inserted into the dural sac (can patch up the defect before it heals on its own)