Diferencia entre revisiones de «Idiopathic intracranial hypertension»
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==Clinical Features== | ==Clinical Features== | ||
*[[Headache]] | |||
*[[Nausea and Vomiting]] | |||
*Vision blurring | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Young, obese women | |||
*[[Headache]] (worse in AM / with manuvers increasing ICP) | |||
*Papilledema (optic atrophy/vision loss) | |||
**can be visualized with [[Ocular ultrasound|ultrasound]] | |||
*[[Neuro Exam]] frequently normal | |||
**May have cranial nerve palsies in severe, most often CN 6 | |||
===Work-Up=== | ===Work-Up=== | ||
*CT scan (negative or slit-like ventricles) | |||
*[[LP]] (Opening pressure >25) | |||
*MR venogram (to r/o cerebral venous sinus thrombosis) | |||
==Management== | ==Management== | ||
*Repeat [[LP]]s (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF | |||
*[[Acetazolamide]] 500mg BID (decrease CSF production) | |||
*[[Furosemide]] 20mg PO BID, give potassium supp as needed | |||
*Weight loss | |||
*CSF Shunt | |||
*Optic nerve sheath fenestration | |||
==Disposition== | ==Disposition== | ||
Revisión del 12:11 28 jul 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
Evaluation
- 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 20mg 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 with ophtho follow up for formal visual field monitoring
External Links
Induction to EM: An approach to headache in the ED. St.Emlyn’s