Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Idiopathic Intracranial Hypertension: A Case Report Abstract: Idiopathic intracranial hypertension can cause significant vision loss if not diagnosed and treated in a timely manner. This case illustrates the management of severe papilledema in a patient unable to tolerate acetazolamide. I. Case History Patient Demographics: 37 year old, overweight, African American female Chief complaint: headaches for several years with whooshing sound in ears, having trouble adjusting from dark to light room Ocular history: no previous surgeries or trauma, last eye exam in October 2013 was normal. Medical history: Hypertension, Otis Externa, Agoraphobia with panic disorder Medications: Amlodipine, Propanol , Losartan, Linzess, Protnoix Social History: Massage therapist, non-smoker, denies alcohol use, has gained 20 lbs this year without any changes to diet or appetite II. Pertinent Findings Clinical: BCVA OD: 20/20 OS: 20/20 EOMs: full range of motion OU, reports pressure with movement, denies diplopia Pupils: 5 mm in dark, 3 mm in light, equally reactive, no APD OU CVF: FTFC OD, OS IOP: 15 mm Hg OD, 16 mm HG Color vision (Ishihara plates): OD: 14/14 OS: 14/14 Slit lamp examination: normal OU Fundus examination: Grade 4 papilledema OU Physical: Height: 5’7” Weight: 205.5 lbs BP: 144/80 BMI: 32 Laboratory studies: Lumbar puncture shows elevated open pressure of 38 cm H2O. Radiology studies: -MRI with and without contrast: normal without optic nerve sheath dilation. -MR Venography with and without contrast: no venous sinous thrombosis III. Differential diagnosis -Idiopathic Intracranial Hypertension -Neuromyelitis optica -Malignant Hypertension -Diabetic papillopathy -Optic disc drusen -Meningitis IV. Diagnosis and discussion Idiopathic Intracranial hypertension (IIH) is a neurological condition where there is elevated intracranial pressure in the absence of a tumor or other diseases. The most common symptoms are persistent headaches and transient episodes of visual loss. IIH occurs predominantly in overweight females in their third decade of life. Upon examination, bilateral optic disc edema is almost always present. To diagnose this condition, a MRI/MRV of the orbit and brain must be obtained to rule out an intracranial mass or venous sinus thrombosis. Subsequently, a lumbar puncture is then performed and the opening pressure must be elevated. V. Treatment and management There are a variety of treatments for idiopathic intracranial hypertension. Weight loss is always recommended along with a low sodium diet. If a patient requires medical therapy, acetazolamide or furosemide is commonly prescribed. Topiramate may also be prescribed to alleviate the headaches associated with this condition. If medical therapy or weight loss is unsuccessful, there are a few surgical therapies such as optic nerve sheath decompression surgery or a ventriculoperitoneal or lumboperitoneal shunt. Patients with IIH should be monitored every month if there is a visual field loss and then every three months, depending on the response to treatment. VI. Clinical Pearls -Ask the patient if there has been any recent weight loss or weight gain -Ask the patient, if female, if she is taking oral contraceptives -Always obtain an MRI/MRV before a lumbar puncture -A normal MRI and elevated opening pressure (>25 mm H2O) must be present to diagnose IIH