Idiopathic intracranial hypertension: Difference between revisions
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*May be due to impaired arachnoid villi absorption | *May be due to impaired arachnoid villi absorption | ||
*Associated with OCPs, vitamin A, tetracycline, and thyroid disorders | *Associated with OCPs, vitamin A, tetracycline, and thyroid disorders | ||
==Work-Up== | |||
#CT scan (negative) | |||
#LP (Opening pressure >25) | |||
==Clinical Features== | ==Clinical Features== | ||
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#Neuro exam frequently normal | #Neuro exam frequently normal | ||
== | ==DDX== | ||
# | #Aneurysm rupture and subarachnoid hemorrhage | ||
# | #Brain tumor | ||
#Encephalitis | |||
#Head injury | |||
#Hydrocephalus (increased fluid around the brain) | |||
#Hypertensive brain hemorrhage | |||
#Intraventricular hemorrhage | |||
#Meningitis | |||
#Subdural hematoma | |||
#Status epilepticus | |||
#Stroke | |||
==Treatment== | ==Treatment== | ||
Revision as of 15:22, 22 July 2012
Background
- Also known as pseudotumor cerebri
- May be due to impaired arachnoid villi absorption
- Associated with OCPs, vitamin A, tetracycline, and thyroid disorders
Work-Up
- CT scan (negative)
- LP (Opening pressure >25)
Clinical Features
- Headache
- N/V
- Vision blurring
Diagnosis
- Young, obese women
- Headache (worse in AM / with manuvers increasing ICP)
- Papilledema (optic atrophy/vision loss)
- Neuro exam frequently normal
DDX
- Aneurysm rupture and subarachnoid hemorrhage
- Brain tumor
- Encephalitis
- Head injury
- Hydrocephalus (increased fluid around the brain)
- Hypertensive brain hemorrhage
- Intraventricular hemorrhage
- Meningitis
- Subdural hematoma
- Status epilepticus
- Stroke
Treatment
- Repeat LPs (decrease CSF pressure)
- Acetazolamide 500mg BID
- Weight loss
- CSF Shunt
- Optic nerve sheath fenestration
Disposition
- Admit for:
- Severe pain
- Focal findings
- Vision changes
- Otherwise, discharge w/ ophtho f/u for formal visual field monitoring
Source
Tintinalli