Basics
- Most common in pre-menopausal obese females
- Most common symptom is headache
- An important preventable cause of blindness
- Normal imaging studies and a lumbar puncture only demonstrates increased pressure
- Most cases are treatable with medication though refractory cases often require an operation
Symptoms and Signs
- Headache
- Decreased visual acuity, double vision, and blindness
- Nausea
- Other symptoms: stiff neck, ringing ears, difficulty walking, eye pain on movement, dizziness
- Worsening of symptoms with bending over or valsalva
Demographics
- Female : Male ratio 2-8:1
- Increased in obesity and women of childbearing age: Peaks in 30s
Diagnosis
- Diagnosis is made on the combination of normal imaging studies (CT and MRI) with increased opening pressure during a lumbar puncture
- Ophthalmologic exam
Treatment
- Weight loss
- Stop offending drugs
- Fluid and salt restriction
- Diuretics- Lasix, Diamox or Neptazane
- Surgery- Optic nerve sheath fenestration or a lumboperitoneal/ventriculoperitoneal shunt
Prognosis
- Spontaneous resolution is common within 1 year
- Permanent visual loss occurs in 2-24%
- Recurs in about 10%
Differential Diagnosis
- Drugs: Keprone, lindane, excess vitamin A, oral contraceptives
- Tumor
- Dural sinus thrombosis
- Chiari malformation
- Infection
- Neurosarcoidosis
- Pseudopapilledema
- Malignant hypertension
- Guillain-Barre syndrome
- head trauma