Neuro

Idiopathic Intracranial Hypertension

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Pathology

Idiopathic increase in intracranial pressure with no evidence of an underlying structural brain pathology, although thought to be due to inadequate absorption of CSF in the arachnoid villi.

Aetiology

Commonly encountered in obese women of child bearing age 

Signs

Papilloedema. 6th nerve palsy may also be seen [false localizing sign]

Symptoms

Headache worse with coughing, sneezing, bending down, visual obscurations (sometimes worse on bending down), pulsatile tinnitus 

Investigations

Bloods: FBC, ESR, haemotinics, coagulation and ANA. 
Imaging: CT/MRI to exclude structural brain lesions 
Special Tests: Lumbar puncture shows an elevated CSF opening pressure
Humphrey’s visual fields should be performed to assess for defects.

Treatment

Conservative: Weight loss
Medical: Lumbar puncture to reduce CSF pressure or Acetazolamide
Surgical: Optic nerve fenestration or lumbo-peritoneal shunt procedure 

Prognosis

10% have progressive visual loss an optic atrophy
Visual loss

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