EMed

Idiopathic Intracranial Hypertension ( IIH )

Background

  • Chronically ↑ICP → papilloedema (±permanent optic atrophy)
  • Obesity
  • Young ♀ >> ♂

Clinical

Symptoms

  • ICP - Headache, neck pain, tinnitus, diplopia
  • Papilloedema - Blurred vision (orthostatic), fields loss

Signs

  • Papilloedema
  • Diplopia (6th N palsy)- may be subtle/bilateral
  • Visual fields

Differential Dx

Investigations

  • FBC/Coag ±thrombosis screen (?sinus thrombosis)
  • Inflam markers ±autoantibodies (vasculitis)
  • Lyme titres (DDx you'd rather not miss)
  • MRI ±MRV (CTB if not available)
  • LP opening pressure (after imaging). CSF=normal

Management

Preserve optic nerve function.

  • Analgesia (not opiates, ±migraine meds, ±triptans)
  • Acetazolamide (lowers ICP)
  • Steroids (transiently lower ICP)
  • Neurosurgery (shunt)
  • NB - long term weight loss

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 18/08/23.