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Benign Intracranial Hypertension

Title

Ñ    Benign Intracranial Hypertension

Definition

Ñ    Increase in intracranial pressure

Without:

Ñ    Intracranial space-occupying lesion

Ñ    Obstruction of ventricular or subarachnoid pathways of CSF flow

Ñ    Infection

Ñ    Hypertensive encephalopathy.

Pathogenesis

Causes

Ñ    Idiopathic

Ñ    Withdrawal of steroids

Ñ    Excessive intake of vitamin A

Ñ    Tetracycline

Ñ    Nitrofurantoin

Pathological Process

Ñ    The pathogenesis of this condition is not clear

Ñ    Sagittal sinus thrombosis results in a similar picture by obstructing CSF drainage

Clinical Features

History

Sex

Ñ    Females > Males

Age

Ñ    20-50 years

CNS

Ñ    Headache

RAG

Ñ    Menstrual irregularities

Examination

E&M

Ñ    Obesity

CNS

Ñ    Enlarged blind spot

Ñ    Papilloedema

Ñ    Lateral rectus palsy:

False localising sign

Complications

CNS

Ñ    Infarction of the optic nerve:

Occurs when papilloedema is severe and long standing

Visual loss, which results, may be permanent

Investigations

Fluids

CSF

Ñ    Lumbar puncture:

Increased CSF pressure but otherwise normal

Imaging

CT scan and MRI

Ñ    Normal

Electrophysiology

EEG

Ñ    Normal

Physiological studies

Visual fields:

Ñ    Record visual fields and recheck regularly

Management

Control

Drugs

Ñ    Analgesics

Ñ    Thiazides:

Reduce intracranial pressure

Ñ    Acetazolamide:

Reduce intracranial pressure

Surgery

Ñ    Serial lumbar puncture

Ñ    Lumboperitoneal shunt

Ñ    Optic nerve fenestration

Prevention

Ñ    Visual fields must be recorded and checked at regular intervals

Ñ    If field defects, other than an enlarged blind spot, occur, despite medical treatment, a surgical procedure should be considered

Ñ    If visual loss occurs it may be permanent despite further treatment

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