NO cases - idiopathic intracranial hypertension .pptx

idiopathic intracranial hypertension

1. IDIOPATHIC INTRACRANIAL HYPERTENSION

2. INTRODUCTION Idiopathic intracranial hypertension, previously known as benign intracranial hypertension or pseudotumor cerebri, is characterized by elevated ICP that by definition has no identifiable cause, obese young adult women are the most commonly affected group. Various medications including the contraceptive pill have been implicated (strictly ‘secondary intracranial hypertension’ if a cause is identified), as well as a range of conditions such as systemic lupus erythematosus, Lyme disease and sleep apnoea syndrome.

3. ETIOLOGY IIH has been associated with the use of exogenous substances such as vitamin A (>100.000 IU/day), tetracycline, minocycline, doxycycline, retinoic acid, and lithium, as well as the use of or withdrawal from corticosteroids. Other potential causes of IIH are sleep apnea and anemia.

4. DIAGNOSIS Symptoms and signs are those of papilloedema , with headache in over 90%. The long-term visual prognosis is usually good, but up to a quarter will have a degree of permanent impairment. Investigation is as for papilloedema : ONSD is increased and MRI may show slit-like ventricles and flattening of the pituitary gland (‘empty sella ’ sign)

5. TREATMENT Weight loss, including via bariatric surgery. Other options include acetazolamide, furosemide, digoxin and analgesia, and in unresponsive cases optic nerve fenestration, lumboperitoneal shunting and transverse dural sinus stenting. Steroids are controversial, but a short course is sometimes used in severe papilloedema . Intravenous mannitol or a lumbal puncture. The ophthalmologist’s role.