Idiopathic Intracranial Hypertension (IIH) Differential Diagnoses

Updated: May 17, 2017
  • Author: Mark S Gans, MD; Chief Editor: Andrew G Lee, MD  more...
  • Print

Diagnostic Considerations

Bilateral optic nerve head edema is presumed to be due to increased intracranial pressure (ICP) secondary to an intracranial tumor until proved otherwise. However, malignant hypertension may also cause bilateral optic nerve edema and is easily ruled out by taking the blood pressure.

If the patient’s blood pressure is normal or only minimally to moderately elevated, neuroimaging studies must be obtained on an urgent basis to rule out a space-occupying lesion or a dural sinus thrombosis. If neuroimaging does not demonstrate any pathologic conditions and if a lumbar puncture demonstrates a raised opening pressure, then a specific cause of increased ICP must be considered (see Etiology). In the absence of a specific offending agent, the diagnosis is presumed to be idiopathic intracranial hypertension (IIH).

In addition to the conditions listed in the differential diagnosis, problems to be considered include the following:

  • Abducens nerve (cranial nerve [CN] VI) palsy

  • Vascular malformations and hematomas of the brain

  • Drusen of the optic nerve heads

  • Malignant hypertension

  • Bilateral infiltrative/infectious/inflammatory optic neuropathy

  • Bilateral optic nerve papillitis

Differential Diagnoses