Idiopathic Intracranial Hypertension

by Carlo Raj, MD

My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides 08 Headache Neuropathology I.pdf
    • PDF
      Download Lecture Overview
    Report mistake

    00:01 Our topic continues with subacute and chronic headache.

    00:04 Here, we’ll take a look at pseudotumor cerebri.

    00:07 Who’s your patient? Patient comes in with this chronic headache, also called idiopathic intracranial hypertension.

    00:14 In other words, this is your IIH.

    00:18 Now, idiopathic because we don’t know exactly as to what causes it.

    00:21 We do know that there’s a particular drug that you should be extremely familiar with that might be a possible etiology, and that’s your ATRA, all-trans retinoic acid.

    00:31 Well, pseudotumor cerebri, as the name implies, pseudo means false, a tumor-like lesion, or should I say tumor-like manifestation.

    00:41 By that, we mean there’s a headache taking place.

    00:43 You’ll find papilledema on fundoscopic examination but absolutely no evidence of a tumor.

    00:50 Described as diffuse, dull, ache, pressure.

    00:53 Remember, this is chronic headache.

    00:55 Onset is a gradual but often progressive.

    00:57 Headache is often worsened by laying down and by physical activity.

    01:02 Blurred vision is common.

    01:04 Horizontal diplopia is occasionally seen, and bilateral cranial nerve VI abducens palsy can be seen.

    01:12 So this will be a good time to review quickly, please, the functions of your abducens cranial nerve VI, And papilledema is quite prominent.

    01:20 Keep that in mind.

    01:22 What does papilledema mean to you? You do a fundoscopic examination and you find there around optic disc, it looks like sun rays.

    01:29 Very bright, huh? That’s your papilledema.

    01:32 Now, with that papilledema, you would think that, “Oh my goodness, that must be prominent.” You’re worried about intracranial pressure being increased, and that is not a good thing.

    01:41 So, keep that in mind.

    01:43 We’ll take a look at epidemiology of pseudotumor cerebri.

    01:47 75% of your patients will be females.

    01:49 That’s where your focus should be.

    01:51 She, will be in her reproductive age between 20 to 40.

    01:55 Vast majority of these females are obese, more common during pregnancy, also seen with steroid therapy, vitamin A toxicity, which I was referring to earlier, your ATRA, all-trans retinoic acid, and maybe perhaps, even tetracycline antibiotics.

    02:13 Make sure you know that these are possible causes or medications that may result as an adverse effect of pseudotumor cerebri.

    02:24 Diagnosis: Imaging initially to rule out a mass lesion because there is no mass.

    02:29 Lumbar puncture to document -- document -- opening pressure.

    02:35 elevated at 250 to 450 millimeters, the water pressure in lateral decubitus.

    02:43 It is important that you know the specifics for opening pressure, please.

    02:49 CSF should otherwise be normal.

    02:53 Formal visual field testing because of papilledema.

    02:56 Early defect is enlargement of blind spot and slight peripheral field constriction.

    03:04 Remember, there is prominent papilledema in these patients, so early on, you would find such defects.

    03:11 Management: Well, here, lumbar puncture, weight loss, carbonic anhydrase inhibitors, Diamox, shunt, optic nerve fenestrations.

    03:23 You do want to relieve some of that pressure that’s taking place with idiopathic intracranial hypertension, AKA, pseudotumor cerebri.

    03:36 Summary of pseudotumor cerebri: Female, early, young, obese.

    03:41 Preventive medicine: Weight loss.

    03:44 Signs and symptoms: Blurred vision, headache.

    03:47 The differentials include, if you remember, we talked about venous sinus thrombosis during pregnancy.

    03:53 Please be very careful, because during pregnancy with estrogen, it may result in the thrombus formation in the sagittal or the transverse sinus.

    03:59 I even showed you an image where the transverse sinus was absent.

    04:05 That’s venous sinus thrombosis.

    04:08 Here, we have pseudotumor, mass lesion, migraines as being differentials.

    04:15 Diagnostic: Lumbar puncture.

    04:16 We talked about earlier, specifically the pressure of 250 to 450 millimeters of water.

    04:22 specifically the pressure of 250 to 450 millimeters of water.

    04:22 Treatment: Weight loss, carbonic anhydrase inhibitors, and shunting.

    About the Lecture

    The lecture Idiopathic Intracranial Hypertension by Carlo Raj, MD is from the course Headache – Pathophysiology.

    Included Quiz Questions

    1. 250 to 450 mmH2O in the lateral decubitus position
    2. 250 to 450 mmH2O in the sitting position
    3. 50 to 100 mm H20 in the sitting position
    4. 50 to 100 mm H20 in the lateral decubitus position
    5. 150 to 200 mm H20 in the lateral decubitus position
    1. Carbonic anhydrase inhibitors
    2. Calcium channel blockers
    3. Beta-blockers
    4. Triptans
    5. Amitriptyline

    Author of lecture Idiopathic Intracranial Hypertension

     Carlo Raj, MD

    Carlo Raj, MD

    Customer reviews

    5,0 of 5 stars
    5 Stars
    4 Stars
    3 Stars
    2 Stars
    1  Star