Idiopathic intracranial hypertension IIH is raised intracranial pressure without a mass lesion or infection. It can cause papilloedema and permanent visual loss if untreated.
Symptoms and risk factors
IIH classically affects young overweight women but can occur in others.
- Headache, pulsatile tinnitus, and transient visual obscurations
- Blurred vision and enlarged blind spot from swollen optic discs
- Occasional horizontal double vision from sixth nerve palsy
- Normal brain imaging aside from signs of raised pressure, with high opening pressure on lumbar puncture
Management
Goals are to relieve pressure and protect vision.
- Weight loss and acetazolamide as first-line therapy
- Regular visual field testing and optic nerve imaging
- Optic nerve sheath fenestration or CSF shunting in progressive or refractory cases
- Review of medications predisposing to IIH such as tetracyclines or vitamin A derivatives
