Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Pathophysiology
- Idiopathic increased intracranial pressure places pressure on the optic nerves to produce visual loss emanating from the blind spots and produces headaches.
Select Radiographic Findings:
- Optic nerve findings:
- Increase in surrounding subarachnoid space
- Flattening of the posterior aspect of the globe
- Partially empty sella turcica
- Stenosis of the lateral aspects of the transverse sinuses
Select Risk Factors
- Female gender
- Medications: Tetracyclines, Vitamin A (Retinol), Lithium, Intrathecal steroids
- Obesity
- Dural venous sinus thrombosis
Clinical Findings
- Headache
- Pulsatile tinnitus: a rhythmic whooshing sound or sometimes referred to as a "washing machine" sound
Signs
- Papilledema
- Enlargement of blind spots on visual field testing and constriction of peripheral fields
- Increased opening pressure on lumbar puncture: greater that 250 mmHg (note that the transient reduction in pressure from release of CSF can cause a temporary relief of the headache).
Treatment
- Emergent temporizing treatment: large volume CSF removal
- Weight loss
- Salt reduction
- Medications
- Acetazolamide
- Diuretics
- Topiramate
- Surgical procedures:
- Shunt placement: reduces the intracranial CSF pressure
- Optic nerve sheath fenestration to preserve vision
Image Reference
Pseudotumor Cerebri
Papilledema