idiopathic intracranial HTN, pseudotumor cerebri Flashcards
Idiopathic intracranial hypertension presentation
headache and visual loss in an obese female;
symptoms are positional and diplopia is common
chronic daily headache,
visual changes,
worsening of headache when lying flat.
idiopathic intracranial hypertension is AKA
pseudotumor cerebri
symptoms of idiopathic intracranial headache are
visual symptoms, tinnitus, diplopia and headaches. headache quality are: chronic holocranial and pulsatile in nature and exacerbated by lying flat and improved by sitting up.
what causes IIH or idiopathic intracranial hypertension?
excessive cerebrospinal fluid production or indequate CSF absorption and seen in young women
which medications are associated to cause idiopathic intracranial hypertension
isotretinoin
tetracyclines
growth hormone
vitamin A.
associated with: kidney failure use of OCP’s steroid use or withdrawal
seen with nitrofurantoin
minocycline
danazol
tamoxifen
levothyroxine
Diagnosis of idiopathic intracranial hypertension includes:
ocular examination- see papilledema or ICP
1st neuro-imaging (CT head) to exclude secondary causes (mass, hemorrhage, cerebral vein thrombosis)
2nd get MRV - to rule out cerebral vein thrombosis.
3rd get LP with elevated opening pressure >250.
MRI to see not much change but can have posterior scleral flattening or empty sella.
what is associated with idiopathic intracranial hypertension?
empty sella seen in 70% of pts but not diagnostic.
endocrine disorders: hypoparathyroidism, addison’s dx
een mostly in young women who had elevated BMI from childhood
how to perform LP in pts with idiopathic intracranial hypertension?
must be done in the lateral decubitis position see opening pressure of >250 see normal CSF studies - no signs of infection
treatment of idiopathic intracranial hypertension
weight loss,
headache prophylaxis,
acetazolamide +/- furosemide.
Short term treatment may include steroids and serial LP for pts awaiting surgery for progressive visual loss.
Surgical options are optic nerve sheath fenestration or CSF shunting procedures.
vision loss with enlarged blind spot, pulsatile tinnitus,, pulsatile headache that is holocranial and worsened by lying flat and ameliorated by sitting up
idiopathic intracranial hypertension (pseudotumor cerebri)
normal imaging an elevated CSF >250 mmH20 in a young woman
idiopathic intracranial hypertension (pseudotumor cerebri)
visual changes associated with idiopathic intracranial hypertension (pseudotumor cerebri)
vision loss, enlarged blind spot diplopia (palsy of abducens nerve CN6) most may not complain of vision changes but with visual testing will find that there is some defect (90%) can see visual obscurations and blurry vision that is transient optic nerves are at risk for damage from increased intracranial pressure.
management of idiopathic intracranial HTN:
get funduscopy and confrontational visual field testing for someone who is at risk or suspected. Also check for ocular motility palsy with abducens nerve palsy (can also be seen in venous sinus thrombosis) Most pts will have some abnormality on visual perimetery and generally see blind spot enlargement or peripheral field reduction.
if someone with suspected idiopathic intracranial HTN has signs of impending visual loss they need to get:
urgent neurosurgery and ventriculoperitoneal shunting or optic nerve fenestration.
if someone has suspected IIH (idiopathic intracranial hypertension) - has daily headaches, obese, horizontal diplopia, fundus showing blurring of optic disc margins?
what test do you get?
If that test is negative what do you get?
if that is negative what do you get?
CT head- rule out intracranial bleeds
If CT head is negative get MRV to rule out thrombosis
If negative MRV, then get LP and look for increased BP.
