Idiopathic intracranial hypertension
Description
- Raised intracranial pressure with normal CSF constituents, no mass lesion, no hydrocephalus, no venous thrombosis
- A diagnosis of exclusion; "idiopathic" only after MRV is clear
- Pseudotumour cerebri is the umbrella term: primary (IIH) vs secondary (an identifiable cause - drug, endocrine, venous)
Classic phenotype
- Obese woman of reproductive age with recent weight gain
- Headache - daily, morning-predominant, worse lying flat, on coughing and straining
- Transient visual obscurations - seconds of greying, often on standing or bending
- Pulsatile tinnitus
- Horizontal diplopia from CN VI palsy (false localising)
- Papilloedema - bilateral disc swelling on fundoscopy
- Back and neck pain, radicular pain
- Visual acuity is preserved until late - the visual field is what is lost
Fulminant IIH
- Severe visual loss developing over days to <4 weeks
- A surgical emergency - acetazolamide alone is inadequate
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