Diferencia entre revisiones de «Idiopathic intracranial hypertension»
(Text replacement - "Category:Neuro" to "Category:Neurology") |
Sin resumen de edición |
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| Línea 3: | Línea 3: | ||
*Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi | *Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi | ||
*Associated with OCPs, vitamin A, [[tetracycline]] and thyroid disorders | *Associated with OCPs, vitamin A, [[tetracycline]] and thyroid disorders | ||
==Clinical Features== | ==Clinical Features== | ||
| Línea 13: | Línea 8: | ||
#[[Nausea and Vomiting]] | #[[Nausea and Vomiting]] | ||
#Vision blurring | #Vision blurring | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Línea 36: | Línea 23: | ||
*[[Stroke]] | *[[Stroke]] | ||
== | ==Diagnosis== | ||
#Young, obese women | |||
#[[Headache]] (worse in AM / with manuvers increasing ICP) | |||
#Papilledema (optic atrophy/vision loss) | |||
##can be visualized with [[Ultrasound: Ocular|ultrasound]] | |||
#[[Neuro Exam]] frequently normal | |||
##May have cranial nerve palsies in severe, most often CN 6 | |||
===Work-Up=== | |||
#CT scan (negative or slit-like ventricles) | |||
#[[LP]] (Opening pressure >25) | |||
#MR venogram (to r/o cerebral venous sinus thrombosis) | |||
==Management== | |||
#Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF | #Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF | ||
#[[Acetazolamide]] 500mg BID (decrease CSF production) | #[[Acetazolamide]] 500mg BID (decrease CSF production) | ||
| Línea 51: | Línea 51: | ||
*Otherwise, discharge w/ ophtho f/u for formal visual field monitoring | *Otherwise, discharge w/ ophtho f/u for formal visual field monitoring | ||
== | ==External Links== | ||
[http://www.stemlynspodcast.org/mobile/e/an-approach-to-headache-in-the-ed-induction-series/ Induction to EM: An approach to headache in the ED. St.Emlyn’s] | |||
==See Also== | |||
[[Ocular ultrasound]] | |||
==References== | |||
<references\> | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
Revisión del 19:37 16 jun 2016
Background
- Also known as pseudotumor cerebri/benign intracranial hypertension (BIH)
- Cause is idiopathic, but believed be due to impaired CSF absorption at arachnoid villi
- Associated with OCPs, vitamin A, tetracycline and thyroid disorders
Clinical Features
- Headache
- Nausea and Vomiting
- Vision blurring
Differential Diagnosis
- Aneurysm rupture and Subarachnoid Hemorrhage
- Brain tumor
- Encephalitis
- Head Injury
- Hydrocephalus (increased CSF)
- Hypertensive brain hemorrhage
- Intraventricular hemorrhage
- Cerebral venous sinus thrombosis
- Meningitis
- Subdural Hematoma
- Status epilepticus
- Stroke
Diagnosis
- Young, obese women
- Headache (worse in AM / with manuvers increasing ICP)
- Papilledema (optic atrophy/vision loss)
- can be visualized with ultrasound
- Neuro Exam frequently normal
- May have cranial nerve palsies in severe, most often CN 6
Work-Up
- CT scan (negative or slit-like ventricles)
- LP (Opening pressure >25)
- MR venogram (to r/o cerebral venous sinus thrombosis)
Management
- Repeat LPs (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
- Acetazolamide 500mg BID (decrease CSF production)
- Furosemide 20 mg PO BID, give potassium supp as needed
- Weight loss
- CSF Shunt
- Optic nerve sheath fenestration
Disposition
- Admit for:
- Severe pain
- Focal findings
- Vision changes
- Otherwise, discharge w/ ophtho f/u for formal visual field monitoring
External Links
Induction to EM: An approach to headache in the ED. St.Emlyn’s
See Also
References
<references\>