Idiopathic Intracranial Hypertension (IIH)
IIH is a condition where there's an increase in intracranial pressure, leading to vision problems, headaches and other symptoms. It occurs when CSF can’t flow normally around the brain and spinal cord.
When the pressure becomes too high, it can:
Put pressure on the optic nerve, causing it to swell (papilloedema), and eventually becomed damage → vision loss
Damage the nerves involved in eye movment → double vision
Risk factors - It can be remembered by thinking of a moon-faced, obese woman who’s trying to treat her acne.
Moon-faced = steroids
Obese, female = self-explanatory
Trying to treat acne = isotretinoin, tetracyclines, COCP
Presentation
Blurry vision
Headache, typically worse when bending down
Hearing problems e.g. rushing, swishing, or ringing sound
Investigations
Eye exam - Fundoscopy (check for papilloedema) and Perimetry (assess visual fields)
MRI Head - Rule out other causes of a raised ICP
Lumbar Puncture - CSF pressure is checked.
N.B. The LP can only be done once a SOL is ruled out.
Management
Manage risk factors e.g. weight loss
Pressure-lowering medication e.g. acetazolamide, furosemide
Consider steroids to relieve headaches and reduce the risk of vision loss
Important Links:
https://bestpractice.bmj.com/topics/en-gb/1070/treatment-algorithm
https://www.aao.org/eye-health/diseases/what-is-idiopathic-intracranial-hypertension
https://www.nhs.uk/conditions/intracranial-hypertension/
"Photograph inside a human left eye of a patient suffering from the medical condition known as "Idiopathic Cranial Hypertension or Pseudo-tumor Cerebri". Which is a condition where pressure is extremely elevated in the brain (as if there is a tumor, but there is not) causing the Optic Nerve to swell, protrude in to the eye, and slow important blood supply.” © DocSee04 CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/)
“Photograph inside a human right eye of a patient suffering from the medical condition known as "Idiopathic Cranial Hypertension or Pseudo-tumor Cerebri". Which is a condition where pressure is extremely elevated in the brain (as if there is a tumor, but there is not) causing the Optic Nerve to swell, protrude in to the eye, and slow important blood supply.” © DocSee04 CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/)