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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, 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