Idiopathic Intracranial hypertension may be a condition thanks to high within the spaces that surround the brain and medulla spinalis. These spaces are crammed with spinal fluid (CSF), which cushions the brain from mechanical injury, provides nourishment, and carries away waste.
Because the symptoms of IIH can resemble those of a brain tumor, it’s sometimes known by the older name pseudotumor cerebri, which suggests “false brain tumor.”
Idiopathic intracranial hypertension (IIH) may be a disorder of unknown etiology that predominantly affects obese women of childbearing age.  the first problem is chronically elevated intracranial pressure (ICP).
Therefore the most vital neurologic manifestation is papilledema (see the image below), which can cause secondary progressive optic atrophy, visual loss, and possible blindness. Although IIH, pseudotumor cerebri, and benign intracranial hypertension (BIH) are synonymous terms within the literature, IIH is that the preferred term.
Idiopathic Intracranial Hypertension Symptoms
The most common symptom is usually an unbearably painful or frequent headache, sometimes related to nausea and vomiting that’s not relieved by medication. The headache often awakens the patient from sleep.
Some patients have treated the ER, where a spinal puncture (spinal tap) is completed as a final resort to ease the headache. Measurement of the opening pressure is inspired during these procedures to assess for intracranial hypertension.
Thenervusopticus connects the inside of every eye, the retina, to the vision centers of the brain. The nervusopticus transmits impulses from the retina to those brain centers.
The earliest sign of papilledema on a visible field trial is understood as an enlarged blind spot. Abnormal CSF pressure also can affect the attention muscles controlling eye movements producing diplopia, but this is often an infrequent event.
Since a rise in pressure inside the brain is explained for papilledema, the symptoms can include:
- visual disturbances, including double vision
- a ringing sound in the ears, often pulse-like
Am I at risk for IIH (Idiopathic Intracranial Hypertension)?
IIH is increasing in incidence in parallel with the current epidemic of obesity. In a large population study involving Iowa and Louisiana, Durcan et al., found the incidence of IIH to be 19 per 100,000 among obese women aged 20 to 44 years who were 20% or more over ideal weight, compared to 0.9 per 100,000 in the general population although less frequent, IIH can also occur in children, men, and the elderly.
In a retrospective study of IIH in the pediatric population, Cinciripini and colleagues found that IIH was rare in children. They interestingly found no gender preference or higher rates of obesity in prepubescent children with IIH. The lack of preference for females and obesity in prepubescent children has also been seen in other extensive retrospective studies. After puberty, obese females are more frequently affected, similar to adult-onset IIH.
How will my eye doctor check for IIH?
You might not need any treatment if IIH isn’t causing severe headaches or vision loss. If you are doing need treatment. Your doctor may prescribe medicine that treats glaucoma to help lower your CSF pressure.
You might also be prescribed diuretics—medicine that helps your body get rid of excess fluid. If you are overweight or obese, your doctor may want you to lose weight. To protect your nervus opticus from further damage, your ophthalmologist may make a small hole or several tiny slits partially of the nervus opticus.
This helps relieve some of the pressure on the nerve. Your ophthalmologist may want you to have a shunt placed in your head If your symptoms are severe. This is a small tube that carries fluid faraway from where it builds up. Then the fluid can be absorbed elsewhere in the body. This procedure lowers the pressure in your head.
Idiopathic Intracranial Hypertension Treatment
The first drug of choice in IIH management is acetazolamide, an old diuretic with a significant carbonic anhydrase inhibitor effect. The efficacy of acetazolamide in IIH has been investigated in two randomized studies.
The authors concluded that extensive controlled research was needed to demonstrate a moderate treatment effect. The reported side effects were acroparesthesia, dysgeusia, fatigue, gastrointestinal symptoms, and nephrolithiasis. The other study was a multicenter, randomized, double-masked, placebo-controlled study of acetazolamide in 165 participants with IIH.
It showed a small but significant beneficial effect of acetazolamide on visual function. Furosemide and other diuretics are sometimes used in IIH, either alone or in combination with acetazolamide, but no randomized controlled trials support its effectiveness.
The treatment goal in patients with idiopathic intracranial hypertension (IIH) is to preserve nervusopticus function while managing increased ICP. Medical management is multifaceted.
Optic nerve function should be carefully monitored with an assessment of acuity, chromatic vision, nervus opticus head appearance, and perimetry. Weight control is recommended for obese patients. Exogenous agents associated with increased ICP should be discontinued.
Patients without a visual loss are most frequently treated with a carbonic anhydrase inhibitor (e.g., acetazolamide) to lower the ICP.
What’s the prognosis?
The frequency and degree to which vision loss occurs in IIH is challenging to determine from the prevailing literature. Depending on the referral population and, therefore, the rigor with which visual function is tested, the prognosis for vision loss in IIH has varied considerably in several series.
Authors writing within the 1960s and 1970s indicated that fewer than 25% of those patients had functionally significant blindness; however, this figure has since been revised upward.
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