Idiopathic intracranial hypertension - Revision history

Danbot: Add MedicationDose entries (acetazolamide, furosemide) with SMW annotations

2026-03-20T18:35:00Z

Add MedicationDose entries (acetazolamide, furosemide) with SMW annotations

@@ Line 43: / Line 43: @@
 **CSF Shunt (ventriculoperitoneal or lumboperitoneal) is often effective if vision is threatened
 **Optic nerve sheath fenestration
 ==Disposition==

Elcatracho: /* Background */

2021-02-27T00:02:27Z

Background

← Older revision		Revision as of 00:02, 27 February 2021
Line 2:		Line 2:
	*Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)		*Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)
	*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi		*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi
	*Associated with obesity, weight gain, pregnancy, cyclosporine, OCPs, [[Vitamin A ~~toxicty~~\|vitamin A >100,000 U/day]], [[tetracycline]], amiodarone, sulfa antibiotics, lithium, thyroid disorders, and historically nalidixic acid (rarely used). Systemic steroid intake and withdrawal may also be causative.		*Associated with obesity, weight gain, pregnancy, cyclosporine, OCPs, [[Vitamin A toxicity\|vitamin A >100,000 U/day]], [[tetracycline]], amiodarone, sulfa antibiotics, lithium, thyroid disorders, and historically nalidixic acid (rarely used). Systemic steroid intake and withdrawal may also be causative.

	==Clinical Features==		==Clinical Features==

Elcatracho: /* Background */

2021-02-27T00:01:35Z

Background

← Older revision		Revision as of 00:01, 27 February 2021
Line 2:		Line 2:
	*Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)		*Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)
	*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi		*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi
	*Associated with obesity, weight gain, pregnancy, cyclosporine, OCPs, vitamin A >100,000 U/day, [[tetracycline]], amiodarone, sulfa antibiotics, lithium, thyroid disorders, and historically nalidixic acid (rarely used). Systemic steroid intake and withdrawal may also be causative.		*Associated with obesity, weight gain, pregnancy, cyclosporine, OCPs, [[Vitamin A toxicty\|vitamin A >100,000 U/day]], [[tetracycline]], amiodarone, sulfa antibiotics, lithium, thyroid disorders, and historically nalidixic acid (rarely used). Systemic steroid intake and withdrawal may also be causative.

	==Clinical Features==		==Clinical Features==

Elcatracho: /* Evaluation */

2021-02-26T23:47:36Z

Evaluation

← Older revision		Revision as of 23:47, 26 February 2021
Line 29:		Line 29:
	**CSF lab studies by [[lumbar puncture]] are negative		**CSF lab studies by [[lumbar puncture]] are negative
	**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc		**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc
	**Recognize that in rare cases, LP's can cause reactive meningeal enhancement (which is why some practitioners delay LP until after MRI). This practice might not be supported in cases where LP is necessary. ~~Source: https://www~~.~~ncbi~~.~~nlm~~.~~nih~~.~~gov~~/~~pmc/articles/PMC5727706~~/		**Recognize that in rare cases, LP's can cause reactive meningeal enhancement (which is why some practitioners delay LP until after MRI). This practice might not be supported in cases where LP is necessary<ref>Wesley SF, Garcia-Santibanez R, Liang J, Pyburn D. Incidence of meningeal enhancement on brain MRI secondary to lumbar puncture. Neurol Clin Pract. 2016;6(4):315-320. doi:10.1212/CPJ.0000000000000262</ref>
	*Outpatient visual field testing is the most important method for following these patients (Humphrey VF's)		*Outpatient visual field testing is the most important method for following these patients (Humphrey VF's)

Elcatracho: /* Evaluation */

2021-02-26T23:46:53Z

Evaluation

← Older revision		Revision as of 23:46, 26 February 2021
Line 25:		Line 25:
	*[[head CT\|CT]] (negative or slit-like ventricles).		*[[head CT\|CT]] (negative or slit-like ventricles).
	*Typically, MRI and MR venogram of the orbit and brain to rule out secondary causes of intracranial pressure such as [[cerebral venous sinus thrombosis]]. If normal, the patient may need LP to determine opening pressure and r/o other causes of optic nerve edema.		*Typically, MRI and MR venogram of the orbit and brain to rule out secondary causes of intracranial pressure such as [[cerebral venous sinus thrombosis]]. If normal, the patient may need LP to determine opening pressure and r/o other causes of optic nerve edema.
	*Consider ocular ultrasound (simple, non-invasive) to assess optic nerve diameter. ~~Source~~: ~~https~~:/~~/www~~.~~ncbi~~.~~nlm~~.~~nih~~.~~gov/pubmed~~/~~27168453~~		*Consider [[ocular ultrasound]] (simple, non-invasive) to assess optic nerve diameter<ref>Bekerman I, Sigal T, Kimiagar I, Almer ZE, Vaiman M. Diagnostic value of the optic nerve sheath diameter in pseudotumor cerebri. J Clin Neurosci. 2016;30:106-109. doi:10.1016/j.jocn.2016.01.018</ref>
	*[[LP]] (Opening pressure >25 cm H2O)		*[[LP]] (Opening pressure >25 cm H2O)
	**CSF lab studies by [[lumbar puncture]] are negative		**CSF lab studies by [[lumbar puncture]] are negative

Elcatracho: /* Evaluation */

2021-02-26T23:40:31Z

Evaluation

← Older revision		Revision as of 23:40, 26 February 2021
Line 26:		Line 26:
	*Typically, MRI and MR venogram of the orbit and brain to rule out secondary causes of intracranial pressure such as [[cerebral venous sinus thrombosis]]. If normal, the patient may need LP to determine opening pressure and r/o other causes of optic nerve edema.		*Typically, MRI and MR venogram of the orbit and brain to rule out secondary causes of intracranial pressure such as [[cerebral venous sinus thrombosis]]. If normal, the patient may need LP to determine opening pressure and r/o other causes of optic nerve edema.
	*Consider ocular ultrasound (simple, non-invasive) to assess optic nerve diameter. Source: https://www.ncbi.nlm.nih.gov/pubmed/27168453		*Consider ocular ultrasound (simple, non-invasive) to assess optic nerve diameter. Source: https://www.ncbi.nlm.nih.gov/pubmed/27168453
	*[[LP]] (Opening pressure >25)		*[[LP]] (Opening pressure >25 cm H2O)
	**CSF lab studies by [[lumbar puncture]] are negative		**CSF lab studies by [[lumbar puncture]] are negative
	**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc		**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc

Hour: /* Background */

2020-03-04T03:27:01Z

Background

← Older revision		Revision as of 03:27, 4 March 2020
Line 2:		Line 2:
	*Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)		*Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)
	*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi		*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi
	*Associated with OCPs, vitamin A, [[tetracycline]] ~~and~~ thyroid disorders		*Associated with obesity, weight gain, pregnancy, cyclosporine, OCPs, vitamin A >100,000 U/day, [[tetracycline]], amiodarone, sulfa antibiotics, lithium, thyroid disorders, and historically nalidixic acid (rarely used). Systemic steroid intake and withdrawal may also be causative.

	==Clinical Features==		==Clinical Features==

Hour: /* Management */

2020-03-04T03:22:19Z

Management

← Older revision		Revision as of 03:22, 4 March 2020
Line 33:		Line 33:

	==Management==		==Management==
			*Treatment may be indicated in the following situations: severe/intractable headache, evidence of progressive decrease in visual acuity or visual field loss. Some ophthalmologists suggest treating all patients with papilledema.
			*Weight loss
			*[[Acetazolamide]] 250mg QID (or 500mg BID) initially building up to 500-1000mg QID if tolerated. Use with caution in sulfa-allergic patients. (decreases CSF production)
			*Discontinue any causative medications
			*Short course of systemic steroids, especially if any plans for surgical intervention
	*Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF		*Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
	*[[Acetazolamide]] 500mg BID (decrease CSF production)
	*[[Furosemide]] 20mg PO BID, give potassium supp as needed		*[[Furosemide]] 20mg PO BID, give potassium supp as needed
	*~~Weight loss~~		*If above treatments are unsuccessful, surgical treatments may be considered.
	*CSF Shunt		**CSF Shunt (ventriculoperitoneal or lumboperitoneal) is often effective if vision is threatened
	*Optic nerve sheath fenestration		**Optic nerve sheath fenestration

	==Disposition==		==Disposition==

Hour: /* Evaluation */

2020-03-04T03:16:54Z

Evaluation

← Older revision		Revision as of 03:16, 4 March 2020
Line 29:		Line 29:
	**CSF lab studies by [[lumbar puncture]] are negative		**CSF lab studies by [[lumbar puncture]] are negative
	**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc		**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc
	**Recognize that in rare cases, LP's can cause reactive meningeal enhancement (which is why some ~~neurologists~~ delay LP until after MRI). This practice might not be supported in cases where LP is necessary. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727706/		**Recognize that in rare cases, LP's can cause reactive meningeal enhancement (which is why some practitioners delay LP until after MRI). This practice might not be supported in cases where LP is necessary. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727706/
	*Outpatient visual field testing is the most important method for following these patients (Humphrey VF's)		*Outpatient visual field testing is the most important method for following these patients (Humphrey VF's)

Hour: /* Evaluation */

2020-03-04T03:16:22Z

Evaluation

← Older revision		Revision as of 03:16, 4 March 2020
Line 29:		Line 29:
	**CSF lab studies by [[lumbar puncture]] are negative		**CSF lab studies by [[lumbar puncture]] are negative
	**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc		**No special CSF studies need to be sent, unless differential includes etiologies for infection, hemorrhage, etc
			**Recognize that in rare cases, LP's can cause reactive meningeal enhancement (which is why some neurologists delay LP until after MRI). This practice might not be supported in cases where LP is necessary. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727706/
	*Outpatient visual field testing is the most important method for following these patients (Humphrey VF's)		*Outpatient visual field testing is the most important method for following these patients (Humphrey VF's)