Idiopathic Intracranial Hypertension Workup

  • Author: Mark S Gans, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 5, 2012
 

Imaging Studies

  • Neuroimaging studies
    • A patient with bilateral disc swelling should undergo urgent neuroimaging studies to rule out an intracranial mass or a dural sinus thrombosis.
    • CT scan is adequate to rule out an intracranial lesion in most instances; however, MRI/venography are more effective in ruling out both a mass lesion and a dural sinus thrombosis, respectively. Although magnetic resonance venography was once considered an elective imaging study for atypical patients, it is becoming increasingly accepted as a routine study for all patients with idiopathic intracranial hypertension.
    • In the setting of idiopathic intracranial hypertension, the findings on neuroimaging studies include normal or small slit-like ventricles, enlarged optic nerve sheaths, and, occasionally, an empty sella.
  • Ultrasonography
    • Standardized A-scan orbital ultrasonography precisely measures the diameter of the optic nerve sheath.
    • If this diameter increases in primary gaze and diminishes by 25% in eccentric gaze (30° test), then increased subarachnoid fluid surrounding the optic nerve is presumably present. This finding is consistent with papilledema if it is bilateral.
    • The drawback of this noninvasive technique is that it requires a highly skilled clinician to obtain reproducible results.
Next

Procedures

  • Lumbar puncture
    • Once an intracranial mass lesion is ruled out, a lumbar puncture is indicated. The opening pressure should be measured with the patient relaxed in the decubitus position to avoid a falsely elevated pressure reading.
    • The clinician performing the procedure must indicate to the ophthalmologist if any specific difficulty was encountered that may have falsely elevated the pressure reading.
    • Unfortunately, some patients demonstrate a transiently normal pressure despite their harboring idiopathic intracranial hypertension. Confirming the disease in these patients is difficult.
    • Besides the value of the opening pressure, the clarity and the color of the cerebrospinal fluid should be noted. In addition, the cerebrospinal fluid should be forwarded for assessment of the cell count, cytology, culture, glucose, protein, and electrolyte concentration. All of these findings are normal in patients with idiopathic intracranial hypertension.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mark S Gans, MD  Associate Professor, Director of Neuro-Ophthalmology, Department of Ophthalmology, McGill University; Clinical Director, Department of Ophthalmology, Adult Sites, McGill University Hospital Center, Interim Chairman of the Department of Ophthalmology, McGill University

Mark S Gans, MD is a member of the following medical societies: American Academy of Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Edsel Ing, MD, FRCSC  Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Toronto East General Hospital, Canada

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Friedman DI, Jacobson DM. Idiopathic intracranial hypertension. J Neuroophthalmol. Jun 2004;24(2):138-45. [Medline].

  2. Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. Nov 26 2002;59(10):1492-5. [Medline].

  3. Miller NR, Newman NJ. Pseudotumor cerebri (benign intracranial hypertension). In: Walsh and Hoyt's Clinical Neuro-Ophthalmology. Vol 1. 5th ed. 1999:523-38.

  4. Bateman GA, Stevens SA, Stimpson J. A mathematical model of idiopathic intracranial hypertension incorporating increased arterial inflow and variable venous outflow collapsibility. J Neurosurg. Mar 2009;110(3):446-56. [Medline].

  5. Wall M. Idiopathic intracranial hypertension (pseudotumor cerebri). Curr Neurol Neurosci Rep. Mar 2008;8(2):87-93. [Medline].

  6. Corbett JJ. The first Jacobson Lecture. Familial idiopathic intracranial hypertension. J Neuroophthalmol. Dec 2008;28(4):337-47. [Medline].

  7. Daniels AB, Liu GT, Volpe NJ, et al. Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol. Apr 2007;143(4):635-41. [Medline].

  8. Digre KB, Nakamoto BK, Warner JE, Langeberg WJ, Baggaley SK, Katz BJ. A comparison of idiopathic intracranial hypertension with and without papilledema. Headache. Feb 2009;49(2):185-93. [Medline].

  9. Corbett JJ, Savino PJ, Thompson HS, et al. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol. Aug 1982;39(8):461-74. [Medline].

  10. Ney JJ, Volpe NJ, Liu GT, Balcer LJ, Moster ML, Galetta SL. Functional Visual Loss in Idiopathic Intracranial Hypertension. Ophthalmology. Jul 28 2009;[Medline].

  11. Bruce BB, Kedar S, Van Stavern GP, et al. Idiopathic intracranial hypertension in men. Neurology. Jan 27 2009;72(4):304-9. [Medline].

  12. Jiraskova N, Rozsival P. Idiopathic intracranial hypertension in pediatric patients. Clin Ophthalmol. Dec 2008;2(4):723-6. [Medline].

  13. Gonzalez-Hernandez A, Fabre-Pi O, Diaz-Nicolas S, Lopez-Fernandez JC, Lopez-Veloso C, Jimenez-Mateos A. [Headache in idiopathic intracranial hypertension]. Rev Neurol. Jul 1-15 2009;49(1):17-20. [Medline].

  14. Mollan SP, Ball AK, Sinclair AJ, et al. Idiopathic intracranial hypertension associated with iron deficiency anaemia: a lesson for management. Eur Neurol. 2009;62(2):105-8. [Medline].

  15. Lin A, Foroozan R, Danesh-Meyer HV, De Salvo G, Savino PJ, Sergott RC. Occurrence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension. Ophthalmology. Dec 2006;113(12):2281-4. [Medline].

  16. Johnson LN, Krohel GB, Madsen RW, March GA Jr. The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri). Ophthalmology. Dec 1998;105(12):2313-7. [Medline].

  17. Brazis PW. Clinical review: the surgical treatment of idiopathic pseudotumour cerebri (idiopathic intracranial hypertension). Cephalalgia. Dec 2008;28(12):1361-73. [Medline].

  18. Spoor TC, McHenry JG. Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri. Arch Ophthalmol. May 1993;111(5):632-5. [Medline].

  19. Sinclair AJ, Kuruvath S, Sen D, et al. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia. Dec 2011;31(16):1627-33. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.