pseudotumor cerebri idiopathic intracranial hypertension
TRANSCRIPT
Idiopathic intracranial Idiopathic intracranial HypertensionHypertension
- Pseudotumor CerebriPseudotumor Cerebri
- Benign Intracranial Benign Intracranial HypertensionHypertension
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Author AnonAuthor Anon
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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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