Idiopathic Intracranial Hypertension

Wednesday, May 1, 2024 by Nisha Gupta, MD

This month we will talk about idiopathic intracranial hypertension (IIH) also known as pseudotumor cerebri.

What is IIH?

IIH is a disorder where there is high pressure in the head from fluid in the brain (cerebrospinal fluid or CSF), that is not draining properly. This pressure can be high enough to cause swelling of the optic nerve and vision loss.

What are the causes?

The cause is not completely understood. Hormones may play a role since the condition tends to affect young women who are overweight. Other cases may be related to specific medications, infection, or high doses of vitamin A. Some other conditions associated with IIH include sleep apnea, hypothyroidism, iron deficiency anemia, lupus, and polycystic ovarian syndrome (PCOS).

What are the symptoms?

Headaches: This is the most common symptom and can be non-specific. It may get worse when straining or bending down.

Vision changes: The vision may seem blurry or dim. One may have episodes of the vision completely disappearing for a few seconds at a time. Double vision and peripheral vision loss may also occur. It may be painful to look at bright lights.

Tinnitus: A ringing or pulsing sensation in the ears.

Nausea and vomiting

How is it detected?

A comprehensive exam including checking the vision and dilating the eyes is needed to diagnosis and monitor IIH. The optic nerve may show signs of swelling and a visual field test can be done to check the peripheral vision. An MRI or CT scan is performed to ensure that the symptoms are from IIH and not another medical condition. A spinal tap or lumbar puncture is done to measure the pressure of the fluid around the brain and spinal cord and test the fluid for an infection.

What are the treatments?

If the IIH is causing symptoms, treatment usually begins with medications to lower the CSF pressure. These medications may include diuretics to remove excess fluid in the body or a short course of steroids to prevent vision loss. Weight loss is encouraged if one is overweight. Surgery may be necessary if the headaches do not resolve or if vision is worsening. The surgery may involve making holes in the optic nerve covering to allow for fluid to drain or placing a shunt in the head to carry the fluid elsewhere to be drained. These procedures may help to decrease the pressure in the head and on the optic nerve.

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