Idiopathic Intracranial Hypertension

Question 1

What is this?

How does it affect vision?

What are its risk factors?

Answer 1

➊ 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.

➋ * When pressure becomes too high it can put pressure on the optic nerve, causing it to swell (papilloedema), and eventually becomed damage → vision loss
* High pressures can also nerves for the extraocular muscles → double vision

➌ * Obesity
* Female
* Steroid-use
* Medications - Isotretinoin, tetracyclines, COCP

N.B. Remember the risk factors 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 = Isotretanoin, tetracyclines, COCP.

Question 2

How does it present?

Answer 2

• Blurry vision
• Headache, typically worse when bending down
• Hearing problems e.g. rushing, swishing, or ringing sound

Question 3

Which investigations should be done?

How is it managed?

Answer 3

➊ * Eye exam - Fundoscopy (check for papilloedema) and Perimetry (assess visual fields)
* MRI Head - Rule out other causes of a raised ICP
* LP - CSF pressure is checked. This can only be done once a SOL is ruled out.

➋ * Manage risk factors e.g. weight loss
* Pressure-lowering medication e.g. acetazolamide, furosemide
* Steroids to relieve headaches and reduce the risk of vision loss