pseudotumor cerebri idiopathic intracranial hypertension

Idiopathic intracranial Idiopathic intracranial HypertensionHypertension

- Pseudotumor CerebriPseudotumor Cerebri

- Benign Intracranial Benign Intracranial HypertensionHypertension

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DefinitionDefinition

1.1. Clinical features of raised Clinical features of raised intracranial pressure (ICP)intracranial pressure (ICP)

2.2. Absence of space-occupying lesion Absence of space-occupying lesion (SOL) on brain imaging(SOL) on brain imaging

3.3. Exclusion of other causesExclusion of other causes

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Physiology of raised ICPPhysiology of raised ICP

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EpidemiologyEpidemiology

• General population = 1 / 100,000 / yrGeneral population = 1 / 100,000 / yr• Women aged 15 – 44 = 3.5 / 100,000 Women aged 15 – 44 = 3.5 / 100,000

/ yr/ yr• Women BMI >29 = 20 / 100,000 / yrWomen BMI >29 = 20 / 100,000 / yr

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Clinical features of Clinical features of Idiopathic Intracranial Idiopathic Intracranial

HypertensionHypertension• HeadacheHeadache• VomitingVomiting• Visual symptoms / signsVisual symptoms / signs

– Transient visual obscurationsTransient visual obscurations– Diplopia (VIth Nerve palsy)Diplopia (VIth Nerve palsy)

• “ “false localising sign”false localising sign”

– Enlarged blind-spotEnlarged blind-spot

• Papilledema on fundus examinationPapilledema on fundus examination• Rest of neurological examination should Rest of neurological examination should

be normalbe normal

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Identifying papilledemaIdentifying papilledema

Normal Papilledema

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Conditions to ExcludeConditions to Exclude

• SOLSOL• HydrocephalusHydrocephalus• Venous Sinus ThrombosisVenous Sinus Thrombosis• Chronic MeningitisChronic Meningitis

•InfectiveInfective•Inflammatory / granulomatousInflammatory / granulomatous•Neoplastic (Carcinomatous / lymphomatous)Neoplastic (Carcinomatous / lymphomatous)

• ““Medical causes” Medical causes” – COCO2 2 retentionretention– Malignant hypertensionMalignant hypertension

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How do we make the How do we make the diagnosis?diagnosis?

• Clinical features of raised ICP without Clinical features of raised ICP without apparent causeapparent cause

• Normal brain imagingNormal brain imaging

• Normal imaging of venous systemNormal imaging of venous system

• LP (serves 3 purposes):LP (serves 3 purposes):1.1. Checks pressure – establishes diagnosisChecks pressure – establishes diagnosis

2.2. CSF analysis – excludes infectious, CSF analysis – excludes infectious, inflammatory and neoplastic etiologiesinflammatory and neoplastic etiologies

3.3. Symptomatic improvementSymptomatic improvement

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Associated FactorsAssociated Factors

• Female > MaleFemale > Male• ObesityObesity• DrugsDrugs

– TetracyclinesTetracyclines– Vitamin AVitamin A

• Iron Deficiency AnemiaIron Deficiency Anemia• Endocrine abnormalitiesEndocrine abnormalities

– HypothyroidismHypothyroidism– HypoparathyroidismHypoparathyroidism– PCOS (probably independent of obesity, acne PCOS (probably independent of obesity, acne

treatment)treatment)

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TreatmentTreatment

• Treat risk factorsTreat risk factors– Weight lossWeight loss– Correct endocrine abnormalitiesCorrect endocrine abnormalities– Stop offending medicationStop offending medication

• Medical ( decrease CSF production)Medical ( decrease CSF production)– Carbonic anhydrase inhibitorsCarbonic anhydrase inhibitors– FurosemideFurosemide

• SurgicalSurgical– CSF diversion proceduresCSF diversion procedures– Optic nerve sheath fenestrationOptic nerve sheath fenestration

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““Benign Intracranial Benign Intracranial Hypertension?”Hypertension?” - No longer!- No longer!May lead to irreversible visual lossMay lead to irreversible visual loss

Normal Optic atrophy

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Follow upFollow up

• Symptoms of raised ICPSymptoms of raised ICP

• Neuro-opthalmological assessmentNeuro-opthalmological assessment

- Visual Field TestingVisual Field Testing

- Fundus ExaminationFundus Examination

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Thanks for your Attention!Thanks for your Attention!

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