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Category: Volume 11 Issue 10 October 2023
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Title: A Case Series on Clinical Profile, Risk Factors and Management of Idiopathic Intracranial Hypertension

Authors: Mohamed Saleem EK, Shobana.N, Sadeeshkumar.V

 DOI: https://dx.doi.org/10.18535/jmscr/v11i10.14

Abstract

Introduction

Idiopathic intracranial hypertension (IIH) occurs when there is raised intracranial pressure (ICP) of unknown etiology and is diagnosed when all other causes of raised ICP have been excluded1. IIH most commonly affects women of child-bearing age and overweight women2. However, men, women of all ages and children of both genders are affected3. Previously the terms like pseudo tumor cerebri and benign intracranial hypertension were used; however, in view of impending loss of vision it cannot be considered benign. Hence the term IIH is used nowadays. The diagnosis of IIH was made using modified Dandy criteria which includes presence of raised intracranial pressure, papilloedema, normal magnetic resonance imaging (MRI) and elevated CSF opening pressure with normal CSF composition. In the absence of papilledema, the diagnosis is challenging and requires specific neuroimaging criteria to be fulfilled.

References

  1. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81:1159–65.
  2. Hatem CF, Yri HM, Sørensen AL, Wegener M, Jensen RH, Hamann S, et al. Long-term visual outcome in a danish population of patients with idiopathic intracranial hypertension. Acta Ophthalmol. 2018;3:23-29.
  3. Ball AK, Clarke CE. Idiopathic intracranial hypertension. Lancet Neurol. 2006;5:433–42.
  4. Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, et al. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol. (2014) 71:693–701. doi: 10.1001/jamaneurol.2014.133
  5. Mezaal M, Saadah M. Idiopathic intracranial hypertension in Dubai: nature and prognosis. Acta Neurologica Scandinavica. (2005)112:298– 302. doi: 10.1111/j.1600-0404.2005.00487.x
  6. Al-Hashel et al. Demographics, Clinical Characteristics and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience. Frontiers in Neurology 2020; 11: 672
  7. Daniels AB, Liu GT, Volpe NJ, Galetta SL, Moster ML, Newman NJ, et al. Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol. (2007)143:635– 41. doi: 10.1016/j.ajo.2006.12.040
  8. Johnson LN, Krohel GB, Madsen RW, March GA Jr. The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri). Ophthalmology.1998; 105:2313–2317.
  9. Kupersmith MJ, Gamell L, Turbin R, Peck V, Spiegel P, Wall M. Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology. 1998; 50:1094–1098.
  10. Thambisetty M, Lavin PJ, Newman NJ, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology. (2007) 68:229– 32. doi: 10.1212/01.wnl.0000251312.19452.ec
  11. Wall M. The headache profile of idiopathic intracranial hypertension. Cephalalgia. (1990) 10:331–5. doi: 10.1046/j.1468-2982.1990.1006331.x
  12. Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, et al. Visual loss in pseudotumor cerebri: follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol. (1982) 39:461–74. doi: 10.1001/archneur.1982.005102000 03001
  13. Wall M, George D. Idiopathic intracranial hypertension: a prospective study of 50 patients. Brain. (1991) 114(Pt 1A):155–80.
  14. D’Amico D, Curone M, Faragò G, Mea E, Tullo V, Proietti A, et al. Headache in patients with idiopathic intracranial hypertension: a pilot study to assess applicability of ICHD-2 diagnostic criteria. Neurol Sci. (2012) 33:189–91. doi: 10.1007/s10072-012-1065-2
  15. Radhakrishnan K, Ahlskog JE, Garitty JA, Kurland LT. Idiopathic intracranial hypetension. Mayo Clin Proc. (1994) 69:169– 80. doi: 10.1016/S0025-6196(12)61045-3
  16. Giuseffi V, Wall M, Siegel PZ, Rojas PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology. (1991) 41:239–44. doi: 10.1212/WNL.41.2_Part_1.239
  17. Digre KB, Nakamoto BK, Warner JE, Langeberg WJ, Baggaley SK, Katz BJ. A comparison of idiopathic intracranial hypertension with and without papilledema. Headache. (2009) 49:185– 93. doi: 10.1111/j.1526-4610.2008.01324.x
  18. Bruce BB, Kedar S, Van Stavern GP, Corbett JJ, Newman NJ, Biousse V. Atypical idiopathic intracranial hypertension: normal BMI and older patients. Neurology. 2010
  19. Lichtenberg I, Blackwood E, Gordon J, Hammond S, Hawke S. The prevalence of idiopathic intracranial hypertension and associated co-morbidities in central western New South Wales (NSW). J Neurol Neurosurg Psychiatry. (2017) 88:e1. doi: 10.1136/jnnp-2017-316074.10
  20. P et al. A Population –Based Case-Control Evaluation between Hormonal Contraceptives and Idiopathic Intracranial Hypertension. Am J Ophtalmol 2019;197:74-79
  21. Yu, Caberry W et al. Anemia and Idiopathic Intracranial Hypertension: A Systemativ Review and Meta-analysis; Journal of Neuro-Ophthalmology;2022
  22. Piper RJ, Kalyvas AV, Young AM, et al. Interventions for idiopathic intracranial hypertension. Cochrane Database Syst Rev 2015; 8:CD003434
  23. Giuseffi V, Wall M, Siegel PZ, Rojas PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology. 1991; 41:239–244

Corresponding Author

Mohamed Saleem EK

Resident, Department of Neurology, Coimbatore Medical College