Pseudotumor Cerebri Lecture

Slide 1: Idiopathic intracranial Hypertension - Pseudotumor Cerebri - Benign Intracranial Hypertension AskTheNeurologist.Com Author Anon

Slide 2: Definition 1. Clinical features of raised intracranial pressure (ICP) 2. Absence of space-occupying lesion (SOL) on brain imaging 3. Exclusion of other causes AskTheNeurologist.Com

Slide 3: Physiology of raised ICP AskTheNeurologist.Com

Slide 4: Epidemiology • General population = 1 / 100,000 / yr • Women aged 15 – 44 = 3.5 / 100,000 / yr • Women BMI >29 = 20 / 100,000 / yr AskTheNeurologist.Com

Slide 5: Clinical features of Idiopathic Intracranial Hypertension • Headache • Vomiting • Visual symptoms / signs – Transient visual obscurations – Diplopia (VIth Nerve palsy) • “false localising sign” – Enlarged blind-spot • Papilledema on fundus examination • Rest of neurological examination should be normal AskTheNeurologist.Com

Slide 6: Identifying papilledema Papilledema Normal AskTheNeurologist.Com

Slide 7: Conditions to Exclude • SOL • Hydrocephalus • Venous Sinus Thrombosis • Chronic Meningitis • Infective • Inflammatory / granulomatous • Neoplastic (Carcinomatous / lymphomatous) • “Medical causes” – CO2 retention – Malignant hypertension AskTheNeurologist.Com

Slide 8: How do we make the diagnosis? • Clinical features of raised ICP without apparent cause • Normal brain imaging • Normal imaging of venous system • LP (serves 3 purposes): 1. Checks pressure – establishes diagnosis 2. CSF analysis – excludes infectious, inflammatory and neoplastic etiologies 3. Symptomatic improvement AskTheNeurologist.Com

Slide 9: Associated Factors • Female > Male • Obesity • Drugs – Tetracyclines – Vitamin A • Iron Deficiency Anemia • Endocrine abnormalities – Hypothyroidism – Hypoparathyroidism – PCOS (probably independent of obesity, acne treatment) AskTheNeurologist.Com

Slide 10: Treatment • Treat risk factors – Weight loss – Correct endocrine abnormalities – Stop offending medication • Medical ( decrease CSF production) – Carbonic anhydrase inhibitors – Furosemide • Surgical – CSF diversion procedures – Optic nerve sheath fenestration AskTheNeurologist.Com

Slide 11: “Benign Intracranial Hypertension?” - No longer! May lead to irreversible visual loss Optic atrophy Normal AskTheNeurologist.Com

Slide 12: Follow up • Symptoms of raised ICP • Neuro-opthalmological assessment - Visual Field Testing - Fundus Examination AskTheNeurologist.Com

Slide 13: Thanks for your Attention! AskTheNeurologist.Com AskTheNeurologist.Com

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