Idiopathic intracranial hypertension

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By Deborah I Friedman MD

Idiopathic intracranial hypertension is also known as Pseudotumor cerebri and Benign intracranial hypertension. -ed.

Idiopathic intracranial hypertension continues to be a diagnostic and therapeutic challenge, and the incidence is rising as obesity becomes more prevalent. Dr. Deborah I Friedman of the University of Texas Southwestern Medical Center updates the clinical features of idiopathic intracranial hypertension in adults and children, secondary causes, current therapies, and the role of cerebral venous sinus disease.

Key points

  • Headaches, transient obscurations of vision and pulsatile tinnitus, are the most frequent early manifestations of idiopathic intracranial hypertension in adults.
  • Obese women of childbearing age are most commonly affected by idiopathic intracranial hypertension, but the syndrome may occur from a secondary cause in children, nonobese patients, and those over 45 years of age.
  • The manifestations of idiopathic intracranial hypertension in children differ from those in adults and include prominent neck or back pain, diplopia, torticollis, other focal neurologic signs, headache, visual loss, and asymptomatic papilledema.
  • Central visual loss at presentation is an ominous sign requiring aggressive intervention.
  • A team approach to management is ideal, and a team leader (generally a neurologist or neuro-ophthalmologist) is critical.