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Idiopathic intracranial hypertension (IIH) (Risk factors (Female, Obesity…
Idiopathic intracranial
hypertension (IIH)
Definition
Syndrome of high ICP w/o
hydrocephalus or mass lesion
and normal CSF
Epidemiology
F>M
Age 15-45y
Risk factors
Female
Obesity
Weight gain
HTN
Menstrual irregularity
Pathophysiology
Unknown
? CSF outflow obstruction at
arachnoid villi/draining veins
? increased CSF production
? increased cerebral oedema
Clinical
presentation
Headache
Daily, throbbing
Associated N&V
Visual
Obscurations (few secs)
Blurring
Reduced acuity (peripheral or central)
Focal signs (rare)
CN III/IV palsy
Diagnosis
History
SH
Living arrangements, occupation,
smoking, alcohol, diet, exercise
FH
Headaches, medical conditions
DH
Meds, allergies
PMH
Headache disorders, besity,
other medical conditions
PC/HPC
Daily headache, visual changes,
focal neurology
Examination
Neuro exam
Reduced visual acuity, blurring
Otherwise normal
Fundoscopy
Papilloedema (bilateral)
Investigations
Imaging
CT/MRI head (nil)
MRV/MRA (nil)
LP
Diagnostic (CSF opening pressure
250 mmH20)
MCS/cytology etc normal
Bedside
Obs (nil)
ECG
Bloods
FBC, U+E, LFT, glucose, lipids, TFTs
Management
Definitive
Conservative
Information, advice, support
Lifestyle (weight loss, diet, stop smoking, exercise)
Regular FU (visual acuity and fields 1m then 3m)
Medical
Analgesia
Indication: headache
E.g. paracetamol, NSAIDs, triptans, TCAs
CA inhibitor
Indication: high ICP
E.g. acetazolamide
MOA: inhibits CA, reduces CSF production
SEs: parasthesia, depression, taste disturbance
Surgical
Optic nerve shealth fenestration
Indication: visual loss
SEs: infection, haemorrhage
Repeat LPs
Indication: visual loss
SEs: unpleasant, low pressure headache
Lumboperitoneal shunt
Indication: visual loss
SE: infection, obstruction, low pressure headache
Initial ABCDE