Download Idiopathic intracranial hypertension (pseudotumor cerebri)

Idiopathic intracranial hypertension
(pseudotumor cerebri)
papilloedema with symptomatic
raised ICP more than 20cm with
normal imaging study of the brain
( absent intracranial mass or
infection)
Hot points
 more common in obese women of childbearing age
 usually self limiting, recurrence is common
 a preventable cause of blindness from optic atrophy
 perimetry is the best test to detect and follow visual loss
Clinical feature
 symptoms and signs of raised ICP i.e. headache with
papilloedema and no focal neurological deficit apart from
abducent palsy (false localizing sign) leading to diplopia
 enlarged blind spot due to papilloedema with conspicuous
absence of altered level of consciousness in spite of raised ICP
diagnosis
 Clinical features
 CSF pressure, more than 20cm H2O
 CSF normal cytology and biochemistry some time low
protein
 Normal imaging study of the brain except for slit ventricles
 MRV to exclude dural venous sinus thrombosis
Associated conditions
 Obesity
 Drugs tetracyclines, nalidixic acid, ciprofluxacine, danazol,
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lithium, amiodarone, phenytoin, nitrofurantoin, nitroglycerine
and steroids
Steroid withdrawal
Hypervitaminosis A
Hypoparathyroidism and hyperthyroidism
Addison disease and cushing disease
Uremia
Iron deficiency anemia
Menstrual irregularity
Oral contraceptive
Differential diagnosis
 Brain mass, may be nonvisible on non enhanced CT scan
 Dural sinus thrombosis
 Meningeal carcinomatosis
 Pseudopapilloedema: anomalous elevation of optic nerve
head associated with hyperopia and drusen, but here there is
positive retinal venous pulsation
 Malignant hypertention
treatment
 Spontaneous resolution is common between 1 month – 1 year
 Recurrence rate 10 %
 There is no reliable predictor of visual loss, i.e visual loss is
unrelated to severity of headache, papilloedema, duration of
symptoms.
 Repeated ophthalmplogical examination by perimetry
treatment
 Treat offending factor
 Weight loss
 Medical treatment
Diuretics
 Carbonic anhydrase inhibitors
 acetazolamide start by 250 mg PO q 8-12 hr increasing the dose till symptomatic relief or
side effects or 2 gm is reached. Contraindicated in renal calculi and allergy to sulpha
 topiramate(topomax) anticonvulsant with carbonic anhydrase inhibition 200 mg PO BID
 frusemide( Lasix )start 160 mg up to 320 mg
 surgical
 serial LP till remission.. 25% remit by 1st LP, aspirate 30cc daily till opening
pressure be bellow 20cm then aspirate weekly with follow up
 lumboperitoneal shunt
 optic nerve sheath fenestration
 subtemporal and suboccipital decompression