What is Benign Intracranial Hypertension?

Rahul's Noteblog Notes on Neurology What is Benign Intracranial Hypertension?

What is Benign Intracranial Hypertension?

Also known as pseudotumor cerebri and idiopathic intracranial hypertension. The initial symptom is usually a headache which awakens the patient from sleep. Other symptoms include blurry vision, nausea, tinnitus and vomiting. Opening CSF pressure is in excess of 180 mm H₂O (normal is 70-180 mm H₂O).

Because of increased intracranial pressure, patients typically complain that headaches become worse when lying flat and better when standing up. Physical examination includes vision loss, sluggish pupillary reflexes to light, papilledema on funduscopy, and abducens nerve (CN 6) palsy. The pathology is unknown; could be caused by impaired CSF absorption by the arachnoid villi. May be caused by medications, trauma, oral contraceptive pills, glucocorticoids, vitamin A, and obesity.

Criteria for Diagnosis of Benign Intracranial Hypertension:

1. Presence of features of increased intracranial pressure in an alert patient.

2. Absence of focal neurological signs except for 6th nerve palsy.

3. Normal CSF exam with increased CSF opening pressure.

4. Absence of ventricular abnormality except reduced size (slit-like ventricles).

Complications:

If left untreated, blindness can develop.

Diagnosis:

Lumbar puncture. MRI of the head may be normal.

Treatment:

First-line treatment is acetazolamide.

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What is Benign Intracranial Hypertension?