Idiopathic intracranial hypertension (IIH) is a disorder that results from an increase in the pressure of the Cerebro-Spinal Fluid (CSF) that cushions and protectsthe brain and spinal cord. The CSF is constantly produced in the brain and reabsorbed back into the bloodstream at a fairly constant rate. This allows the fluid pressure around the brain to remain constant.
The cause is usually not known. A common explanation for increased pressure is a problem with the reabsorption of this fluid back into the body, which causes the pressure to increase. Sometimes the cause is determined and is referred to as “secondary” intracranial hypertension.
The majority of cases of IIH are adult obese females. Other risk factors include use of certain medications (oral contraceptives, steroids, vitamin A, Isotretinoin, lithium, growth hormone, nitrofurantoin, phenytoin, sulfa drugs, minocycline, Tamoxifen, naladixic acid, thyroid replacement, tetracycline, and some chemotherapeutic drugs).
Medical conditions associated with idiopathic intracranial hypertension include blockage of the brain’s venous drainage (dural sinus thrombosis), renal disease, head injuries, Lyme disease, lupus, acute sinusitis, measles, blood clotting disorders, anemia and malnutrition.
Yes, and can generally be divided into two groups. The first group includes prepubescent children and tends to be “secondary” which affects males and females equally. The second group, post pubescent teenagers, tends to fit the adult stereotype.
If idiopathic intracranial hypertension is suspected, an ophthalmologist usually examines the optic nerve for swelling (papilledema) and the visual field (if possible) for defects.
If MRI is unremarkable, a lumbar puncture (spinal tap) is performed to determine the pressure as well as content of the CSF. High pressure of CSF is indicative of IIH.
The ophthalmologist monitors vision and the papilledema. Weight loss for the obese is recommended. The mainstay of treatment is medication to lower the CSF pressure, which decreases papilledema. The four groups of medications include carbonic anhydrase inhibitors, steroids, migraine medication, and diuretics.
Less commonly surgery of the spinal cord (shunting) or the optic nerve (fenestration of optic nerve sheath) are utilized to lower pressure.
The most important thing anyone can do to improve this condition is lose weight if they are obese. Ask your doctor about local resources and clinics designed to assist you in your weight loss.
As many as 10 percent of the people with pseudotumor cerebri experience progressively worsening vision and may eventually become blind. Even if symptoms have resolved, a recurrence can occur months or even years later. It is important to have regular follow-up eye examinations.
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