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Idiopathic Intracranial Hypertension

 Diagnosis: Idiopathic Intracranial Hypertension, previously known as “pseudotumor cerebri” 

Clinical Keywords: IIH, pseudotumor cerebri, headache, partially empty sella, papilledema 

 

Clinical Problems: 

1. Headache 

2. Visual changes 

3. Ringing in the ears (tinnitus) 

 

In Plain Language: 

The brain is surrounded by a clear fluid called cerebrospinal fluid which is also found in the nerves going to the eyes (optic nerves) and within large spaces inside the brain (ventricles). In some people, usually obese women of child-bearing age, the pressure of the fluid can become abnormally high without a specific cause. This is called idiopathic intracranial hypertension and can lead to symptoms such as headache, visual changes, and ringing in the ears. 

Medical Description: 

Cerebrospinal fluid (CSF) completely surrounds the brain and all intracranial contents within the skull as well as flows into the optic nerves. The fluid is made in the choroid plexus within the large spaces on the inside of the brain called ventricles. 

In some patients, usually obese women of child-bearing age, the pressure of the cerebrospinal fluid can increase and result in mass effect (pushing) on the nearby parts of the brain which is called idiopathic intracranial hypertension (IIH). The cause of the increased pressure is unknown (idiopathic) and may or may not result in symptoms. Imaging findings for IIH are nonspecific but some findings that may suggest the diagnosis in combination with the right age/gender and clinical symptoms, include: 

– Partially empty sella: increased CSF pressure which flattens the pituitary gland 

– Increased CSF within the optic nerve sheaths with or without tortuosity 

– Flattening or reversal of the optic disk (portion of the nerve right at the globe or eyeball); seen clinically as papilledema 

– Cerebellar tonsillar ectopia: downward displacement of the cerebellar tonsils through the foramen magnum 

– Narrowing of the bilateral transverse dural venous sinuses 

– Increased subcutaneous face of the neck and scalp 

If you have headaches and/or idiopathic intracranial hypertension and would like a personalized video explanation of your findings, sign up for Mediphany. 

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