Materiały źródłowe

• #1 Idiopathic intracranial hypertension: Update on diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7385768/

  Idiopathic intracranial hypertension is a condition of raised intracranial pressure of unknown cause. […] Diagnosis includes brain imaging with venography to exclude structural causes and venous sinus thrombosis. […] Lumbar puncture reveals pressure greater than 250 mmCSF with normal constituents. […] If papilloedema is confirmed, then it is essential to exclude intracranial causes of raised ICP. […] All patients with confirmed papilloedema should have urgent magnetic resonance imaging (MRI) or computed tomography (CT) of the head with MR or CT venography within 24 hours. […] A diagnosis of IIH requires CSF opening pressure greater than 250 mmCSF. […] Long-term treatment of IIH is best achieved with weight loss, although in the shorter term, drugs that reduce CSF production may be useful and surgical intervention is sometimes required to save vision in patients who are rapidly deteriorating. […] LP pressure measurement is one of the five requirements to confirm diagnosis of IIH, and therefore should not be considered in isolation to the other clinical and investigation criteria.

• #2 The diagnosis and management of idiopathic intracranial hypertension and the associated headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4916517/

  Idiopathic intracranial hypertension (IIH) is a challenging disorder with a rapid increasing incidence due to a close relation to obesity. […] A summary of diagnosis, symptoms, headache characteristics and course, as well as existing evidence of treatment strategies is presented and strategies for investigations and management are proposed. […] At time of diagnosis various degrees of visual impairment are present in up to 90% of patients with IIH […] In addition, diagnosis is often delayed as the general knowledge of IIH is limited and multiple doctors from various specialties have been consulted before patients are identified. […] The symptoms are clearly summarized […] Headache is present in around 93% of patients at the time of diagnosis, usually being constant or occurring daily or nearly daily.

• #3 How is a Patient Diagnosed? | Harvard Medical School Department of Ophthalmology

  https://eye.hms.harvard.edu/book/how-patient-diagnosed-and-treated

  A recent update to the modified Dandy Criteria for IIH is used for diagnosis. […] Diagnosis relies on accurately identifying papilledema and excluding secondary forms of intracranial hypertension with neuroimaging. A lumbar puncture to ensure normal cerebrospinal fluid (CSF) constituents and confirm an elevated opening pressure is also needed. […] A diagnosis of definite IIH is reached if the patient has: Either papilledema or a sixth nerve palsy. Normal MRI/MRV imaging of the head. And a lumbar puncture showing an elevated opening pressure (25 cm H2O in adults or 28 cm H2O in sedated children) with normal spinal fluid constituents. […] The presence of multiple MRI features of raised intracranial pressure can assist in making an accurate diagnosis of IIH in those patients without evidence of papilledema or a sixth nerve palsy.

• #4 Idiopathic intracranial hypertension | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/idiopathic-intracranial-hypertension-1?lang=us

  Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a syndrome with signs and symptoms of increased intracranial pressure but where a causative mass or hydrocephalus is not identified. […] The modified Dandy criteria were revised to establish the diagnosis in the Idiopathic Intracranial Hypertension Treatment Trial: presence of signs and symptoms of increased intracranial pressure, absence of localizing findings on neurologic exam except those known to occur from increased intracranial pressure, absence of deformity, displacement, or obstruction of the ventricular system and otherwise normal neurodiagnostic studies, except for evidence of increased CSF pressure; abnormal neuroimaging except for empty sella turcica, optic nerve sheath with filled out CSF spaces, and smooth-walled non-flow-related venous sinus stenosis or collapse should lead to another diagnosis, awake and alert patient, no other cause of increased intracranial pressure present.

• #5 Guideline for Diagnosis and Treatment of Idiopathic Intracranial Hypertension – Neurology Advisor

  https://www.neurologyadvisor.com/news/guideline-for-diagnosis-and-treatment-of-idiopathic-intracranial-hypertension/

  Intracranial hypertension The European Headache Federation has issued recommendations on how to best diagnose and treat idiopathic intracranial hypertension. […] The researchers defined IIH via the diagnostic criteria established by Friedman et al: Papilledema, Normal neurological examination (except sixth cranial nerve palsy), Neuroimaging: normal brain parenchyma (no hydrocephalus, mass, structural lesion, or meningeal enhancement); venous thrombosis excluded in all, Normal cerebrospinal fluid (CSF) constituents, Elevated lumbar puncture pressure 25 cm CSF. […] For patients with suspected IIH, ophthalmic examination should include visual acuity, a pupil examination, formal visual field assessment, and dilated fundal examination to evaluate the papilledema. […] The researchers recommend that the diagnostic algorithm for IIH include several components, including: Neuroimaging, Lumbar puncture, Blood tests.

• #6 Idiopathic Intracranial Hypertension (IIH): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1214410-overview

  The preferred neuroimaging procedure is a combination of a magnetic resonance image (MRI) of the brain and magnetic resonance venography (MRV) to rule out both an intracranial mass lesion and a dural sinus thrombosis or stenosis. If MRI is not available on the initial presentation, at the very least a computed axial tomography (CAT scan) of the brain can be performed. […] The Dandy criteria (described by Dandy in 1937 and later modified) were the original criteria used to diagnose IIH and are as follows: Symptoms and signs of increased ICP. No other localizing neurologic signs other than those related to increased ICP (eg, unilateral or bilateral sixth nerve paresis, papilledema, or papilledema-related visual loss). Cerebrospinal fluid (CSF) may show increased pressure, but there are no cytologic or chemical abnormalities. Neuroimaging reveals radiographic signs of increased ICP but no structural cause or hydrocephalus. No other causes of increased ICP are found through workup.

• #7 Idiopathic intracranial hypertension | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/idiopathic-intracranial-hypertension-1?lang=us

  A competing set of diagnostic criteria were proposed in 2013 and are also commonly used. The criteria place patients into one of four diagnostic subgroups: definite idiopathic intracranial hypertension: opening pressure 25 cm CSF (H2O) and papilledema, probable idiopathic intracranial hypertension: opening pressure 25 cm CSF and papilledema, definite idiopathic intracranial hypertension without papilledema: opening pressure 25 cm CSF and abducens nerve palsy, suggested idiopathic intracranial hypertension without papilledema: opening pressure 25 cm CSF and 3 out of 4 neuroimaging signs (empty sella, flattening of the posterior aspect of the globe, distension of the perioptic subarachnoid space, or transverse venous sinus stenosis). […] Imaging of the brain with CT or MRI without and with contrast, and possibly CT or MR venography, is essential in patients with suspected idiopathic intracranial hypertension to exclude elevated CSF pressure due to other causes such as brain tumor, dural sinus thrombosis, hydrocephalus, etc.

• #8 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  Idiopathic intracranial hypertension (IIH) is increased pressure in your skull. It occurs because of cerebrospinal fluid buildup around your brain. The cause is unknown. Treatments are available. […] To diagnose IIH, a healthcare provider will take your medical history and perform a physical exam. Theyll learn more about what symptoms you experience and order several diagnostic tests to rule out conditions with similar symptoms. Tests may include: Eye exam with a visual field test to check for blind spots in your vision, Brain CT scan or MRI, Spinal tap (lumbar puncture). […] The goals of IIH treatment are to decrease pressure on your brain and prevent vision loss. Depending on the severity, your healthcare provider may recommend: Taking medications, Undergoing surgery, Weight management. […] Timely treatment at the first sign of vision changes or symptoms can help reduce your risk of complications like permanent vision loss. Treatment is often successful at relieving symptoms. Your healthcare provider can give you the best information on what you can expect in your situation.

• #9 The diagnosis and management of idiopathic intracranial hypertension and the associated headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4916517/

  The current diagnostic criteria for headache attributed to IIH given by the International Classification of Headache Disorders (ICHD-III beta) […] Recently, these criteria have been field tested and new validated criteria have been proposed. […] Characteristic for the condition is the presence of a pulsatile tinnitus that is believed to arise from intensified vascular pulsation occurring with high ICP. […] Patients with papilledema often present with transitory visual obscurations which can be a manifestation of increased bulb pressure, retinal ischemia or transient ischemia at the optic nerve caused by papilledema. […] In the clinical setting IIH is documented by a lumbar puncture with manometry. […] Opening pressure values above 25 cm H2O are considered abnormal […] However, it is only a point measurement and with high diurnal ICP variability repeated pressure measurements may be required in patients presenting with an atypical phenotype or with only marginally increased opening pressure.

• #10 Intracranial hypertension

  https://www.nhs.uk/conditions/intracranial-hypertension/

  A GP may suspect you have intracranial hypertension (IH) if you have symptoms of increased pressure on your brain, such as vision problems and headaches. […] If a GP thinks you have IH they’ll refer you to a hospital specialist. […] You may have several different tests to diagnose IH, such as: an examination to check functions such as your muscle strength, reflexes and balance. Any problems could be a sign of an issue with your brain or nerves, an assessment of your eyes and vision, a CT scan or MRI scan of your brain, a lumbar puncture, where a needle is inserted into your spine to check for high pressure in the fluid that surrounds your brain and spinal cord. […] Idiopathic IH may be diagnosed if you have increased pressure on your brain and no other cause can be found.

• #11 The diagnosis and management of idiopathic intracranial hypertension and the associated headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4916517/

  Idiopathic intracranial hypertension (IIH) is a challenging disorder with a rapid increasing incidence due to a close relation to obesity. […] A summary of diagnosis, symptoms, headache characteristics and course, as well as existing evidence of treatment strategies is presented and strategies for investigations and management are proposed. […] At time of diagnosis various degrees of visual impairment are present in up to 90% of patients with IIH […] In addition, diagnosis is often delayed as the general knowledge of IIH is limited and multiple doctors from various specialties have been consulted before patients are identified. […] The symptoms are clearly summarized […] Headache is present in around 93% of patients at the time of diagnosis, usually being constant or occurring daily or nearly daily.

• #12 Idiopathic Intracranial Hypertension (IIH) Workup: Approach Considerations, Laboratory Studies, MRI and CT Scanning

  https://emedicine.medscape.com/article/1214410-workup

  If idiopathic intracranial hypertension (IIH) is suspected based on clinical findings, it is important for clinicians to evaluate the visual fields and optic fundi, even if the patient does not report visual symptoms. […] The diagnosis of IIH is primarily clinical and confirmed through brain imaging, ideally using MRI with magnetic resonance venography, which typically shows normal results except for possible narrowing of the venous transverse sinus. […] If it is not contraindicated, a lumbar puncture should be performed to analyze cerebrospinal fluid (CSF). An elevated opening pressure with normal CSF composition supports the diagnosis of idiopathic intracranial hypertension. […] Additionally, the clinical presentation of IIH can be mimicked by certain medications and disorders, which should be ruled out to confirm the diagnosis.

• #13

  https://www.aao.org/eye-health/diseases/what-is-idiopathic-intracranial-hypertension

  How Is Idiopathic Intracranial Hypertension Diagnosed? […] Your ophthalmologist will do a series of tests to diagnose idiopathic intracranial hypertension (IIH). They may include: […] An eye exam. Your ophthalmologist will check your optic nerve for swelling. They will also test to see if you have any blank spots in your field of vision. […] An MRI or CT scan. These scans help to check whether your symptoms are due to IIH or caused by other medical problems. […] A spinal tap. This is when your doctor measures the pressure of your spinal fluid. They will also draw fluid to test it for any problems.

• #14 Managing idiopathic intracranial hypertension in the eye clinic | Eye

  https://www.nature.com/articles/s41433-024-03140-y

  Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure (ICP) with specific diagnostic criteria. […] Despite clear diagnostic criteria which are widely accepted, there is evidence of diagnostic difficulty for some in confirming a diagnosis of IIH. […] Hence a full ophthalmic examination is required to confirm papilloedema and rule out pseudopapilloedema. […] Following confirmation of true disc oedema, if it has not yet occurred, a full examination of the extent of visual dysfunction should be made. […] The first step is to check blood pressure to rule out malignant hypertension. Neuroimaging is then required, and a preferred modality by the authors is magnetic resonance imaging (MRI) of the brain and orbits, with fat suppression technique, with and without contrast.

• #15 Idiopathic Intracranial Hypertension (IIH) Workup: Approach Considerations, Laboratory Studies, MRI and CT Scanning

  https://emedicine.medscape.com/article/1214410-workup

  Once an intracranial mass lesion has been excluded, a lumbar puncture is recommended. […] It is crucial to measure the opening pressure with the patient in a relaxed decubitus position to avoid inaccurately high readings. […] An opening pressure above 25 cm H2O is considered elevated, yet patients presenting with typical IIH symptoms but normal pressures may still be classified as having „probable” IIH. […] The appearance, clarity, and color of the CSF should be recorded, and samples should be analyzed for cell count, cytology, culture, and levels of glucose, protein, and electrolytes. Typically, these parameters are normal in IIH patients. […] If clinical indicators point to idiopathic intracranial hypertension, it is essential to assess the visual fields and optic fundi, regardless of whether patients present with visual symptoms or not. […] Optical coherence tomography (OCT) also can be a helpful tool to evaluate and monitor optic nerve head edema, as it can characterize and quantify changes in the retinal nerve fiber layer that may be associated with acute and chronic changes in intracranial pressure.

• #16 A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension | Practical Neurology

  https://pn.bmj.com/content/14/6/380

  Adult patients who present with papilloedema and symptoms of raised intracranial pressure need urgent multidisciplinary assessment including neuroimaging, to exclude life-threatening causes. […] Where there is no apparent underlying cause for the raised intracranial pressure, patients are considered to have idiopathic intracranial hypertension (IIH). […] The diagnostic criteria of IIH are well known and have evolved since Dandy’s initial description in 1937; they include a CSF opening pressure of 25cmH2O. […] However, these criteria recommend imaging only to exclude a venous sinus thrombosis in patients without the typical IIH phenotype (obesity and female sex). […] We feel, however, that it is essential to exclude venous sinus thrombosis (using MRI or CT with venography) in all patients presenting with pseudotumour cerebri, since being female and obese does not preclude the diagnosis of venous sinus thrombosis.

• #17 Idiopathic Intracranial Hypertension – Neurology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.25.2.

  Lumbar puncture confirms the presence of increased opening pressure. In addition, the evaluation of CSF constituents is useful to exclude secondary causes of increased intracranial pressure. […] A formal visual field examination is mandatory for the evaluation and monitoring of patients with IIH. Visual field loss occurs in most patients with IIH, but it is often unnoticed unless formal perimetry is obtained. […] Papilledema is the hallmark of this condition and thus fundoscopy is necessary to evaluate the optic nerve head. […] Secondary causes of intracranial hypertension should be excluded. Several agents can induce a clinical syndrome that mimics IIH, including lithium, tetracycline antibiotics, vitamin A derivatives, and glucocorticoid withdrawal, among others. Conditions leading to cerebral venous hypertension, such as cerebral venous sinus thrombosis or arteriovenous fistula, should be excluded.

• #18 Idiopathic intracranial hypertension: Update on diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7385768/

  Idiopathic intracranial hypertension is a condition of raised intracranial pressure of unknown cause. […] Diagnosis includes brain imaging with venography to exclude structural causes and venous sinus thrombosis. […] Lumbar puncture reveals pressure greater than 250 mmCSF with normal constituents. […] If papilloedema is confirmed, then it is essential to exclude intracranial causes of raised ICP. […] All patients with confirmed papilloedema should have urgent magnetic resonance imaging (MRI) or computed tomography (CT) of the head with MR or CT venography within 24 hours. […] A diagnosis of IIH requires CSF opening pressure greater than 250 mmCSF. […] Long-term treatment of IIH is best achieved with weight loss, although in the shorter term, drugs that reduce CSF production may be useful and surgical intervention is sometimes required to save vision in patients who are rapidly deteriorating. […] LP pressure measurement is one of the five requirements to confirm diagnosis of IIH, and therefore should not be considered in isolation to the other clinical and investigation criteria.

• #19 Idiopathic Intracranial Hypertension (IIH) Workup: Approach Considerations, Laboratory Studies, MRI and CT Scanning

  https://emedicine.medscape.com/article/1214410-workup

  If idiopathic intracranial hypertension (IIH) is suspected based on clinical findings, it is important for clinicians to evaluate the visual fields and optic fundi, even if the patient does not report visual symptoms. […] The diagnosis of IIH is primarily clinical and confirmed through brain imaging, ideally using MRI with magnetic resonance venography, which typically shows normal results except for possible narrowing of the venous transverse sinus. […] If it is not contraindicated, a lumbar puncture should be performed to analyze cerebrospinal fluid (CSF). An elevated opening pressure with normal CSF composition supports the diagnosis of idiopathic intracranial hypertension. […] Additionally, the clinical presentation of IIH can be mimicked by certain medications and disorders, which should be ruled out to confirm the diagnosis.

• #20 Guideline for Diagnosis and Treatment of Idiopathic Intracranial Hypertension – Neurology Advisor

  https://www.neurologyadvisor.com/news/guideline-for-diagnosis-and-treatment-of-idiopathic-intracranial-hypertension/

  To diagnose IIH, the researchers call magnetic resonance imaging the gold standard of care for excluding secondary causes of elevated ICP and for identifying structural alterations associated with IIH. […] Lumbar puncture is mandatory to diagnose IIH. IIH is characterized by a normal CSF composition and an opening pressure that does not exceed 25 cm H2O in adults and 28 cm H2O in children. […] At investigation [IIH] requires careful exclusion of secondary causes through history, neuroimaging, [lumbar puncture] and ophthalmic examination. Once a diagnosis is established of typical IIH, it requires regular visual monitoring, neurological input for active headache management, and direct counselling regarding weight loss, the researchers wrote.

• #21 Idiopathic Intracranial Hypertension (IIH): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1214410-overview

  The preferred neuroimaging procedure is a combination of a magnetic resonance image (MRI) of the brain and magnetic resonance venography (MRV) to rule out both an intracranial mass lesion and a dural sinus thrombosis or stenosis. If MRI is not available on the initial presentation, at the very least a computed axial tomography (CAT scan) of the brain can be performed. […] The Dandy criteria (described by Dandy in 1937 and later modified) were the original criteria used to diagnose IIH and are as follows: Symptoms and signs of increased ICP. No other localizing neurologic signs other than those related to increased ICP (eg, unilateral or bilateral sixth nerve paresis, papilledema, or papilledema-related visual loss). Cerebrospinal fluid (CSF) may show increased pressure, but there are no cytologic or chemical abnormalities. Neuroimaging reveals radiographic signs of increased ICP but no structural cause or hydrocephalus. No other causes of increased ICP are found through workup.

• #22 A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension | Practical Neurology

  https://pn.bmj.com/content/14/6/380

  Adult patients who present with papilloedema and symptoms of raised intracranial pressure need urgent multidisciplinary assessment including neuroimaging, to exclude life-threatening causes. […] Where there is no apparent underlying cause for the raised intracranial pressure, patients are considered to have idiopathic intracranial hypertension (IIH). […] The diagnostic criteria of IIH are well known and have evolved since Dandy’s initial description in 1937; they include a CSF opening pressure of 25cmH2O. […] However, these criteria recommend imaging only to exclude a venous sinus thrombosis in patients without the typical IIH phenotype (obesity and female sex). […] We feel, however, that it is essential to exclude venous sinus thrombosis (using MRI or CT with venography) in all patients presenting with pseudotumour cerebri, since being female and obese does not preclude the diagnosis of venous sinus thrombosis.

• #23 How is a Patient Diagnosed? | Harvard Medical School Department of Ophthalmology

  https://eye.hms.harvard.edu/book/how-patient-diagnosed-and-treated

  The presence of three of four MRI features of intracranial hypertension is highly specific for IIH: Empty sella, Optic nerve sheath distension, Posterior globe flattening, Transverse venous sinus stenosis. […] MRI of the brain with and without contrast and MRV of the head should be obtained urgently to exclude an intracranial mass lesion, hydrocephalus, or cerebral venous sinus thrombosis. […] LP should be performed after neuroimaging in order to confirm normal spinal fluid constituents (cell counts, protein, and glucose) and elevated opening pressure.

• #24 Diagnosis and treatment of disorders of intracranial pressure: consensus statement of the Spanish Society of Neurology’s Headache Study Group | Neurología (English Edition)

  https://www.elsevier.es/en-revista-neurologia-english-edition–495-resumen-diagnosis-treatment-disorders-intracranial-pressure-S2173580824000488

  Brain MRI is fundamental in diagnosis, particularly in ruling out other causes of intracranial hypertension, and should always include a venography sequence in order to rule out venous sinus thrombosis, among other disorders. […] The most typical findings are total or partial empty sella syndrome, posterior globe flattening or even optic disc protrusion into the vitreous humour, and tortuous optic nerves with thickening of the optic nerve sheath, although none of these findings are specific, as they may also be observed in healthy individuals; nonetheless, sensitivity is increased if a combination of signs is observed. […] The diagnosis of spontaneous intracranial hypotension is based on the presence of indirect radiological signs in patients with compatible symptoms and detection of the cause of the disorder.

• #25 How is a Patient Diagnosed? | Harvard Medical School Department of Ophthalmology

  https://eye.hms.harvard.edu/book/how-patient-diagnosed-and-treated

  The presence of three of four MRI features of intracranial hypertension is highly specific for IIH: Empty sella, Optic nerve sheath distension, Posterior globe flattening, Transverse venous sinus stenosis. […] MRI of the brain with and without contrast and MRV of the head should be obtained urgently to exclude an intracranial mass lesion, hydrocephalus, or cerebral venous sinus thrombosis. […] LP should be performed after neuroimaging in order to confirm normal spinal fluid constituents (cell counts, protein, and glucose) and elevated opening pressure.

• #26 Idiopathic intracranial hypertension: Update on diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7385768/

  Idiopathic intracranial hypertension is a condition of raised intracranial pressure of unknown cause. […] Diagnosis includes brain imaging with venography to exclude structural causes and venous sinus thrombosis. […] Lumbar puncture reveals pressure greater than 250 mmCSF with normal constituents. […] If papilloedema is confirmed, then it is essential to exclude intracranial causes of raised ICP. […] All patients with confirmed papilloedema should have urgent magnetic resonance imaging (MRI) or computed tomography (CT) of the head with MR or CT venography within 24 hours. […] A diagnosis of IIH requires CSF opening pressure greater than 250 mmCSF. […] Long-term treatment of IIH is best achieved with weight loss, although in the shorter term, drugs that reduce CSF production may be useful and surgical intervention is sometimes required to save vision in patients who are rapidly deteriorating. […] LP pressure measurement is one of the five requirements to confirm diagnosis of IIH, and therefore should not be considered in isolation to the other clinical and investigation criteria.

• #27

  https://step2.medbullets.com/neurology/120306/idiopathic-intracranial-hypertension-pseudotumor-cerebri

  A 28-year-old woman is referred to a headache neurologist for throbbing left-sided headaches that are refractory to numerous analgesics. Her headache is associated with episodes of double vision and „vision blurriness.” She also endorses worsening headache with a cough and has experienced nausea. Her BMI is 32 kg/m2. Neurological examination is notable for a left-sided sixth nerve palsy, decreased visual fields, and papilledema on fundoscopy. She undergoes an MRI brain with MR venography, which is unremarkable. A lumbar puncture demonstrates a significant opening pressure with normal protein, glucose, and cells. She is started on acetazolamide and is referred to an Ophthalmologist for possible optic nerve sheath fenestration. […] Lumbar puncture is the most accurate diagnostic test for IIH.

• #28

  https://step2.medbullets.com/neurology/120306/idiopathic-intracranial-hypertension-pseudotumor-cerebri

  The indication for lumbar puncture is performed after secondary causes of increased intracranial pressure have been excluded on neuroimaging. […] Elevated opening pressure is a finding in lumbar puncture. […] Ophthalmic examination is indicated to determine the extent of optic nerve damage from the increased intracranial pressure.

• #29 A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension | Practical Neurology

  https://pn.bmj.com/content/14/6/380

  The diagnosis can be difficult and the consequences of error can lead either to the neglect of a serious treatable cause of raised intracranial pressure, blindness or inappropriate treatment of patients who do not have IIH. […] After excluding a structural intracranial lesion, patients require a lumbar puncture, performed with the patient in the lateral decubitus position. […] The opening pressure is important, so every effort should be made to ensure all equipment is at hand; this includes having more than one packet of manometer tubes to avoid being unable to measure a pressure 40cm CSF. […] We suggest slightly straightening the patient’s legs at the hips to avoid compressing the intra-abdominal cavity. […] The column of CSF in the manometer needs sufficient time to settle—there should be small oscillations with breathing—before recording the reading.

• #30 Idiopathic Intracranial Hypertension (IIH) Workup: Approach Considerations, Laboratory Studies, MRI and CT Scanning

  https://emedicine.medscape.com/article/1214410-workup

  Once an intracranial mass lesion has been excluded, a lumbar puncture is recommended. […] It is crucial to measure the opening pressure with the patient in a relaxed decubitus position to avoid inaccurately high readings. […] An opening pressure above 25 cm H2O is considered elevated, yet patients presenting with typical IIH symptoms but normal pressures may still be classified as having „probable” IIH. […] The appearance, clarity, and color of the CSF should be recorded, and samples should be analyzed for cell count, cytology, culture, and levels of glucose, protein, and electrolytes. Typically, these parameters are normal in IIH patients. […] If clinical indicators point to idiopathic intracranial hypertension, it is essential to assess the visual fields and optic fundi, regardless of whether patients present with visual symptoms or not. […] Optical coherence tomography (OCT) also can be a helpful tool to evaluate and monitor optic nerve head edema, as it can characterize and quantify changes in the retinal nerve fiber layer that may be associated with acute and chronic changes in intracranial pressure.

• #31 A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension | Practical Neurology

  https://pn.bmj.com/content/14/6/380

  The diagnosis can be difficult and the consequences of error can lead either to the neglect of a serious treatable cause of raised intracranial pressure, blindness or inappropriate treatment of patients who do not have IIH. […] After excluding a structural intracranial lesion, patients require a lumbar puncture, performed with the patient in the lateral decubitus position. […] The opening pressure is important, so every effort should be made to ensure all equipment is at hand; this includes having more than one packet of manometer tubes to avoid being unable to measure a pressure 40cm CSF. […] We suggest slightly straightening the patient’s legs at the hips to avoid compressing the intra-abdominal cavity. […] The column of CSF in the manometer needs sufficient time to settle—there should be small oscillations with breathing—before recording the reading.

• #32 A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension | Practical Neurology

  https://pn.bmj.com/content/14/6/380

  The diagnosis can be difficult and the consequences of error can lead either to the neglect of a serious treatable cause of raised intracranial pressure, blindness or inappropriate treatment of patients who do not have IIH. […] After excluding a structural intracranial lesion, patients require a lumbar puncture, performed with the patient in the lateral decubitus position. […] The opening pressure is important, so every effort should be made to ensure all equipment is at hand; this includes having more than one packet of manometer tubes to avoid being unable to measure a pressure 40cm CSF. […] We suggest slightly straightening the patient’s legs at the hips to avoid compressing the intra-abdominal cavity. […] The column of CSF in the manometer needs sufficient time to settle—there should be small oscillations with breathing—before recording the reading.

• #33 The diagnosis and management of idiopathic intracranial hypertension and the associated headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4916517/

  The target of IIH management is to reduce ICP with the main goals of preservation of vision and relief of headache. […] The first drug of choice in IIH management is acetazolamide, an old diuretic with a significant carbonic anhydrase inhibitor effect. […] The effect of topiramate and acetazolamide was compared in an open-label study of 40 IIH patients, with a main focus on visual fields. […] Although headache is the most frequent symptom in patients with IIH, headache management is a field yet to be explored, since the existing treatment trials have been focused on ICP changes or visual outcome rather than a headache relief. […] In many patients IIH headache responds well to management of ICP by cerebrospinal fluid withdrawal or medical treatment, with most improvement occurring within the first month.

• #34 Diagnosis | IIH UK – (Idiopathic intracranial hypertension)

  https://www.iih.org.uk/product/4/2/diagnosis

  To diagnose IIH you may see a neurologist and an ophthalmologist. Doctors need to talk to you about what you have been experiencing and perform a physical examination. It is important that other conditions are ruled out before diagnosing IIH. […] It is essential that other conditions such as venous sinus thrombosis (blood clot in brain), anaemia (lack of red blood cells) and certain drugs such as some antibiotics or vitamin A containing drugs are ruled out, as they require different treatment. […] To be diagnosed with IIH you will need brain scans and a lumbar puncture(LP), sometimes called a spinal tap. It is vital that lumbar puncture reading is performed with you relaxed and lying on your side for the reading to be accurate. […] For doctors to be able to diagnose IIH all the following 5 things need to be present: Papilloedema (swelling of the eye nerves). Normal neurological examination (sixth nerve palsy causing double vision is allowed). Normal brain imaging. This is usually with computerized tomography(CT) or magnetic resonance imaging (MRI) scans. They should also include a scan of the veins of the brain to exclude venous sinus thrombosis. Normal brain fluid (CSF) analysis. Elevated lumbar puncture opening pressure above 25cm (for some people a pressure above 25cm may be normal for them)

• #35 Idiopathic Intracranial Hypertension: Symptoms, Treatment, More

  https://www.healthline.com/health/idiopathic-intracranial-hypertension

  Idiopathic intracranial hypertension (IIH) is a disorder associated with increased fluid pressure around your brain. […] Even though anyone can experience IIH, its most commonly diagnosed in women between the ages of 20 to 44 with obesity. […] The symptoms of IIH overlap with the symptoms of many other conditions, including brain tumors. Many of the diagnostic tools doctors use for IIH help to rule out other disorders. […] If a healthcare professional believes you might have IIH, some possible diagnostic tests include: physical examination and history, magnetic resonance venography (MRV), computed tomography (CT), lumbar puncture, vision tests performed by an ophthalmologist, complete blood count (CBC). […] If, after testing, your doctor cant diagnose you with anything else and your symptoms still fit the criteria, they may diagnose you with IIH. […] After being treated for IIH, you can expect to have regular examinations with an eye doctor as well as a primary care physician to monitor for signs of permanent vision loss or a recurrence of IIH.

• #36 A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension | Practical Neurology

  https://pn.bmj.com/content/14/6/380

  The diagnosis can be difficult and the consequences of error can lead either to the neglect of a serious treatable cause of raised intracranial pressure, blindness or inappropriate treatment of patients who do not have IIH. […] After excluding a structural intracranial lesion, patients require a lumbar puncture, performed with the patient in the lateral decubitus position. […] The opening pressure is important, so every effort should be made to ensure all equipment is at hand; this includes having more than one packet of manometer tubes to avoid being unable to measure a pressure 40cm CSF. […] We suggest slightly straightening the patient’s legs at the hips to avoid compressing the intra-abdominal cavity. […] The column of CSF in the manometer needs sufficient time to settle—there should be small oscillations with breathing—before recording the reading.

• #37 Inaccuracy of idiopathic intracranial hypertension diagnosis in case reports | Eye

  https://www.nature.com/articles/s41433-023-02499-8

  We reviewed the medical case report literature to determine the proportion of cases of idiopathic intracranial hypertension (IIH) that were either inappropriately labelled as IIH or prematurely given this diagnosis. […] A total of 33/185 case reports (17.8%) either incorrectly labelled a patient as having IIH or did not perform all of the investigations necessary to make a diagnosis of IIH. […] There is a high prevalence of premature or inappropriate diagnoses of IIH in the peer-reviewed case report literature. Adherence to published diagnostic criteria is needed when publishing IIH case reports, and authors are expected to report all relevant data in their report to ensure that an accurate diagnosis is made. […] Among all included case reports, 82.2% (152/185) were appropriately classified as IIH and satisfied diagnostic criteria.

• #38 Awareness, Diagnosis and Management of Idiopathic Intracranial Hypertension

  https://www.mdpi.com/2075-1729/11/7/718

  Therefore, more awareness about the disease is needed. […] The main barrier for an early detection and diagnosis of IIH is probably a lack of general knowledge of the disease. […] The early symptoms can be unspecific and vague and IIH in the early stages can be difficult to recognize. […] The diagnosis of papilledema is not always easy, especially in the emergency room and/or in the headache clinic. […] The most common diagnostic error in the diagnosis of IIH is actually inaccurate ophthalmoscopic examination in headache patients. […] Thus, there is a huge unmet need for better, valid and atraumatic diagnostic tools for IIH, especially in the early disease stages but certainly also later for follow-up visits. […] The main targets in the early phase of the disease are to identify the disorder and preserve visual function.

• #39 Diagnosis of Idiopathic Intracranial Hypertension Is Frequently Incorrectlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na40140/2016/01/19/diagnosis-idiopathic-intracranial-hypertension-frequently

  Diagnosis of Idiopathic Intracranial Hypertension Is Frequently Incorrect. A tertiary neuro-ophthalmology referral center discovered other etiologies in a high proportion of diagnosed patients. The diagnosis of idiopathic intracranial hypertension (IIH) is supported by papilledema, sometimes with headache, typically in an overweight woman aged 20 to 40. Cerebrospinal fluid (CSF) opening pressure ≥25 cm H2O without another primary etiology is confirmatory. In many cases, ophthalmologic and CSF examinations can be difficult to interpret. Of group 1, 39.5% were misdiagnosed before referral. Final diagnoses included primary headache disorder, pseudopapilledema, optic atrophy, retinopathy, physiologic blind spot, and thrombus of the superior sagittal sinus. In group 2, IIH was confirmed in only 19%. These findings support the use of a comprehensive work-up to confirm IIH and exclude mimics. Neuro-ophthalmology referral is appropriate, particularly when history, exam, and testing are inconclusive. After an MRI and MR venography, CSF should be obtained with careful attention to technique in obtaining opening pressure. For suspected IIH, starting medical treatment (i.e., acetazolamide) while awaiting a second opinion may be reasonable. Neuro-ophthalmology evaluation is beneficial before recommending any type of surgical procedure for IIH.

• #40 Awareness, Diagnosis and Management of Idiopathic Intracranial Hypertension

  https://www.mdpi.com/2075-1729/11/7/718

  Therefore, more awareness about the disease is needed. […] The main barrier for an early detection and diagnosis of IIH is probably a lack of general knowledge of the disease. […] The early symptoms can be unspecific and vague and IIH in the early stages can be difficult to recognize. […] The diagnosis of papilledema is not always easy, especially in the emergency room and/or in the headache clinic. […] The most common diagnostic error in the diagnosis of IIH is actually inaccurate ophthalmoscopic examination in headache patients. […] Thus, there is a huge unmet need for better, valid and atraumatic diagnostic tools for IIH, especially in the early disease stages but certainly also later for follow-up visits. […] The main targets in the early phase of the disease are to identify the disorder and preserve visual function.

• #41 Inaccuracy of idiopathic intracranial hypertension diagnosis in case reports | Eye

  https://www.nature.com/articles/s41433-023-02499-8

  We reviewed the medical case report literature to determine the proportion of cases of idiopathic intracranial hypertension (IIH) that were either inappropriately labelled as IIH or prematurely given this diagnosis. […] A total of 33/185 case reports (17.8%) either incorrectly labelled a patient as having IIH or did not perform all of the investigations necessary to make a diagnosis of IIH. […] There is a high prevalence of premature or inappropriate diagnoses of IIH in the peer-reviewed case report literature. Adherence to published diagnostic criteria is needed when publishing IIH case reports, and authors are expected to report all relevant data in their report to ensure that an accurate diagnosis is made. […] Among all included case reports, 82.2% (152/185) were appropriately classified as IIH and satisfied diagnostic criteria.

• #42 Inaccuracy of idiopathic intracranial hypertension diagnosis in case reports | Eye

  https://www.nature.com/articles/s41433-023-02499-8

  The most common reason that case reports did not meet diagnostic criteria included: a lack of MRV in atypical patient cases (42.4%, n=14), no papilledema in addition to a lack of characteristic neuroimaging features (33.3%, n=11), intracranial hypertension being secondary to a documented cause (12.1%, n=4), normal LP opening pressure in addition to other factors (12.1%,n=4), no description of neuroimaging (6.1%, n=2), and abnormal CSF composition (6.1%, n=2). […] The high prevalence of diagnostic inaccuracies persisted among all countries and most specialties, reaching as high as 33.3% in case reports written by authors affiliated with paediatrics. […] The primary limitation of our review was that our interpretation of IIH relied heavily on the amount of information provided by individual studies. […] In conclusion, we found a high prevalence of inaccurate and premature IIH diagnoses in included case reports.

• #43 Idiopathic Intracranial Hypertension

  https://practicalneurology.com/diseases-diagnoses/headache-pain/idiopathic-intracranial-hypertension/31655/

  Treatment of idiopathic intracranial hypertension should be started as soon as diagnosis is confirmed to prevent vision loss. […] The diagnosis of IIH is made using the Friedman criteria, whereas the International Classification of Headache Disorders (ICHD-3) outlines the diagnostic criteria of the associated headache. […] If papilledema is present, the next diagnostic step is to obtain an MRI with and without contrast and venography to exclude the presence of a structural abnormality or cerebral venous sinus thrombosis (CVST). […] Opening pressure of 25 cm or more cerebrospinal fluid (CSF) and otherwise normal CSF confirms the diagnosis of IIH. […] In IIHWOP, the diagnosis can be made if all the above criteria are met except papilledema and cranial nerve 6 palsy is present. […] The ICHD-3 criteria for IIH-related headache also require elevation in CSF pressure.

• #44 Idiopathic intracranial hypertension | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/idiopathic-intracranial-hypertension-1?lang=us

  A competing set of diagnostic criteria were proposed in 2013 and are also commonly used. The criteria place patients into one of four diagnostic subgroups: definite idiopathic intracranial hypertension: opening pressure 25 cm CSF (H2O) and papilledema, probable idiopathic intracranial hypertension: opening pressure 25 cm CSF and papilledema, definite idiopathic intracranial hypertension without papilledema: opening pressure 25 cm CSF and abducens nerve palsy, suggested idiopathic intracranial hypertension without papilledema: opening pressure 25 cm CSF and 3 out of 4 neuroimaging signs (empty sella, flattening of the posterior aspect of the globe, distension of the perioptic subarachnoid space, or transverse venous sinus stenosis). […] Imaging of the brain with CT or MRI without and with contrast, and possibly CT or MR venography, is essential in patients with suspected idiopathic intracranial hypertension to exclude elevated CSF pressure due to other causes such as brain tumor, dural sinus thrombosis, hydrocephalus, etc.

• #45 How is a Patient Diagnosed? | Harvard Medical School Department of Ophthalmology

  https://eye.hms.harvard.edu/book/how-patient-diagnosed-and-treated

  A recent update to the modified Dandy Criteria for IIH is used for diagnosis. […] Diagnosis relies on accurately identifying papilledema and excluding secondary forms of intracranial hypertension with neuroimaging. A lumbar puncture to ensure normal cerebrospinal fluid (CSF) constituents and confirm an elevated opening pressure is also needed. […] A diagnosis of definite IIH is reached if the patient has: Either papilledema or a sixth nerve palsy. Normal MRI/MRV imaging of the head. And a lumbar puncture showing an elevated opening pressure (25 cm H2O in adults or 28 cm H2O in sedated children) with normal spinal fluid constituents. […] The presence of multiple MRI features of raised intracranial pressure can assist in making an accurate diagnosis of IIH in those patients without evidence of papilledema or a sixth nerve palsy.

• #46 Idiopathic intracranial hypertension: from concise history to current management | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00730-7

  The symptoms of intracranial hypertension, otherwise from adults, are subtle in pediatrics. […] The clinical course of IIH is not always monophasic, although it can relapse. […] Headaches that still arise after IIH remission can be a valuable sign of recurrence, especially in patients with a headache before IIH occurred; therefore, significant clinical findings of IIH relapse are an increased CSF pressure on a lumbar puncture or papilledema.

• #47 Fulminant Idiopathic Intracranial Hypertension – EyeWiki

  https://eyewiki.org/Fulminant_Idiopathic_Intracranial_Hypertension

  Increased intracranial pressure of unknown cause is called Idiopathic Intracranial Hypertension (IIH). […] Fulminant IIH (FIH) is a subtype of IIH that occurs in 2-3% of patients with IIH and results in severe, rapidly progressive vision loss within one month of IIH symptom onset. […] These patients are at a high risk for permanent vision loss and require prompt medical diagnosis and treatment. […] The diagnostic criteria for FIH are: 1. Diagnostic criteria for IIH fulfilled (but including papilledema), 2. Less than 4 weeks between symptom onset and severe loss of visual acuity or field, 3. Rapid worsening of vision over days. […] The diagnosis of IIH is made by the modified Dandy criteria consisting of: (1) signs and symptoms of increased intracranial hypertension, (2) normal neurological exam (except 6th nerve palsy and papilledema) including mental status examination, (3) no evidence of hydrocephalus, mass, structural, or vascular lesion on neuroimaging, (4) increased lumbar puncture opening pressure (25 cm H2O), (5) Normal cerebral spinal fluid (CSF) contents, and (6) no other cause of increased ICP identified.

• #48 Fulminant Idiopathic Intracranial Hypertension – EyeWiki

  https://eyewiki.org/Fulminant_Idiopathic_Intracranial_Hypertension

  Increased intracranial pressure of unknown cause is called Idiopathic Intracranial Hypertension (IIH). […] Fulminant IIH (FIH) is a subtype of IIH that occurs in 2-3% of patients with IIH and results in severe, rapidly progressive vision loss within one month of IIH symptom onset. […] These patients are at a high risk for permanent vision loss and require prompt medical diagnosis and treatment. […] The diagnostic criteria for FIH are: 1. Diagnostic criteria for IIH fulfilled (but including papilledema), 2. Less than 4 weeks between symptom onset and severe loss of visual acuity or field, 3. Rapid worsening of vision over days. […] The diagnosis of IIH is made by the modified Dandy criteria consisting of: (1) signs and symptoms of increased intracranial hypertension, (2) normal neurological exam (except 6th nerve palsy and papilledema) including mental status examination, (3) no evidence of hydrocephalus, mass, structural, or vascular lesion on neuroimaging, (4) increased lumbar puncture opening pressure (25 cm H2O), (5) Normal cerebral spinal fluid (CSF) contents, and (6) no other cause of increased ICP identified.

• #49 Fulminant Idiopathic Intracranial Hypertension – EyeWiki

  https://eyewiki.org/Fulminant_Idiopathic_Intracranial_Hypertension

  A diagnostic lumbar puncture should then be performed for patients with suspected IIH. […] The management of FIH differs from typical IIH because of the increased risk of permanent vision loss. […] Rapid diagnosis and management of FIH is necessary to prevent permanent vision loss. […] Prompt treatment is required to prevent permanent vision loss and includes temporizing medical measures until surgical intervention can be performed. […] Surgical intervention should not be delayed as the chance of visual recovery decreases quickly over time.

• #50 Pseudotumor cerebri (idiopathic intracranial hypertension) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudotumor-cerebri/diagnosis-treatment/drc-20354036

  Once you’ve had pseudotumor cerebri, you’ll need to have your vision checked regularly to monitor changes. […] After discussing your symptoms with your family doctor, he or she might refer you to a doctor trained in brain and nervous system conditions (neurologist) or eye conditions (ophthalmologist) or both (neuro-ophthalmologist) for further evaluation.

• #51 Preserving vision, easing headaches: Timely multidisciplinary care for idiopathic intracranial hypertension – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/preserving-vision-easing-headaches-timely-multidisciplinary-care-for-idiopathic-intracranial-hypertension/mac-20468518

  Mayo Clinic’s cerebral spinal fluid (CSF) dynamics clinic provides a multidisciplinary, specialized approach to the management of idiopathic intracranial hypertension (IIH). […] Timely diagnosis and treatment are essential for the optimal treatment of IIH. […] Mayo Clinic has experience with sophisticated imaging and lumbar puncture to confirm the diagnosis, as well as venous sinus stenting for treatment. […] At Mayo’s CSF dynamics clinic, neurologists and neuro-ophthalmologists work together to confirm the diagnosis of IIH. […] The results of MRI, magnetic resonance venography (MRV) and lumbar puncture are carefully evaluated to exclude a diagnosis of tumor, venous sinus thrombosis, infection or inflammation. […] „We find that as many as 40% of patients referred to us for IIH may not actually have the condition,” Dr. Chen says.

• #52 Preserving vision, easing headaches: Timely multidisciplinary care for idiopathic intracranial hypertension – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/preserving-vision-easing-headaches-timely-multidisciplinary-care-for-idiopathic-intracranial-hypertension/mac-20468518

  Mayo Clinic’s cerebral spinal fluid (CSF) dynamics clinic provides a multidisciplinary, specialized approach to the management of idiopathic intracranial hypertension (IIH). […] Timely diagnosis and treatment are essential for the optimal treatment of IIH. […] Mayo Clinic has experience with sophisticated imaging and lumbar puncture to confirm the diagnosis, as well as venous sinus stenting for treatment. […] At Mayo’s CSF dynamics clinic, neurologists and neuro-ophthalmologists work together to confirm the diagnosis of IIH. […] The results of MRI, magnetic resonance venography (MRV) and lumbar puncture are carefully evaluated to exclude a diagnosis of tumor, venous sinus thrombosis, infection or inflammation. […] „We find that as many as 40% of patients referred to us for IIH may not actually have the condition,” Dr. Chen says.

• #53 Idiopathic Intracranial Hypertension (IIH): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1214410-overview

  Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology characterized by chronically elevated intracranial pressure (ICP), and the most important neurologic manifestation is papilledema. The presentation of acute/subacute symptoms of increased ICP and papilledema should be considered a clinical emergency until a neuroimaging study confirms the absence of an intracranial mass. If left untreated, chronic papilledema may lead to secondary progressive optic atrophy, visual field loss, and ultimately blindness. […] It is essential to perform urgent neuroimaging studies on any patient presenting with bilateral optic nerve edema in order to rule out an intracranial mass. Once a mass lesion is ruled out, a lumbar puncture (LP) is performed to confirm an elevated opening pressure and to evaluate the cerebrospinal fluid (CSF) contents (description of the fluid, analysis of the protein, glucose, blood cell type/count, culture). An LP should never be performed prior to neuroimaging.

• #54 Diagnosis | IIH UK – (Idiopathic intracranial hypertension)

  https://www.iih.org.uk/product/4/2/diagnosis

  To diagnose IIH you may see a neurologist and an ophthalmologist. Doctors need to talk to you about what you have been experiencing and perform a physical examination. It is important that other conditions are ruled out before diagnosing IIH. […] It is essential that other conditions such as venous sinus thrombosis (blood clot in brain), anaemia (lack of red blood cells) and certain drugs such as some antibiotics or vitamin A containing drugs are ruled out, as they require different treatment. […] To be diagnosed with IIH you will need brain scans and a lumbar puncture(LP), sometimes called a spinal tap. It is vital that lumbar puncture reading is performed with you relaxed and lying on your side for the reading to be accurate. […] For doctors to be able to diagnose IIH all the following 5 things need to be present: Papilloedema (swelling of the eye nerves). Normal neurological examination (sixth nerve palsy causing double vision is allowed). Normal brain imaging. This is usually with computerized tomography(CT) or magnetic resonance imaging (MRI) scans. They should also include a scan of the veins of the brain to exclude venous sinus thrombosis. Normal brain fluid (CSF) analysis. Elevated lumbar puncture opening pressure above 25cm (for some people a pressure above 25cm may be normal for them)

• #55 Idiopathic Intracranial Hypertension

  https://practicalneurology.com/diseases-diagnoses/headache-pain/idiopathic-intracranial-hypertension/31655/

  Treatment of idiopathic intracranial hypertension should be started as soon as diagnosis is confirmed to prevent vision loss. […] The diagnosis of IIH is made using the Friedman criteria, whereas the International Classification of Headache Disorders (ICHD-3) outlines the diagnostic criteria of the associated headache. […] If papilledema is present, the next diagnostic step is to obtain an MRI with and without contrast and venography to exclude the presence of a structural abnormality or cerebral venous sinus thrombosis (CVST). […] Opening pressure of 25 cm or more cerebrospinal fluid (CSF) and otherwise normal CSF confirms the diagnosis of IIH. […] In IIHWOP, the diagnosis can be made if all the above criteria are met except papilledema and cranial nerve 6 palsy is present. […] The ICHD-3 criteria for IIH-related headache also require elevation in CSF pressure.

• #56 Managing idiopathic intracranial hypertension in the eye clinic | Eye

  https://www.nature.com/articles/s41433-024-03140-y

  A lumbar puncture (LP) is then a recommended investigation. […] The opening pressure should be recorded, and above 25cm of water (H2O) is considered abnormally high. […] A definite diagnosis of IIH was made as per the diagnostic criteria. […] The main principles of treatment of IIH are to protect vision, treat the underlying cause, and reduce headache morbidity. […] The use of acetazolamide, a carbonic anhydrase inhibitor, is the most widespread treatment currently used to treat IIH to help with reduction of ICP and to protect the vision. […] In 2014 the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) provided evidence that acetazolamide, in association with weight loss, was effective in reducing ICP and improving papilloedema in patients with mild to moderate visual field changes.

• #57 Diagnosis and management of idiopathic intracranial hypertension – VJNeurology

  https://www.vjneurology.com/video/noffrvtxmbs-diagnosis-and-management-of-idiopathic-intracranial-hypertension/

  Idiopathic intracranial hypertension is a condition of unknown etiology that affects primarily overweight, reproductive-aged women. […] It is well-documented that an early diagnosis leads to a better visual outcome. […] The currently recommended strategies are a combination of medication, lifestyle changes, and weight loss in the vast majority of patients.

• #58 Diagnosis and management of idiopathic intracranial hypertension – VJNeurology

  https://www.vjneurology.com/video/noffrvtxmbs-diagnosis-and-management-of-idiopathic-intracranial-hypertension/

  Idiopathic intracranial hypertension is a condition of unknown etiology that affects primarily overweight, reproductive-aged women. […] It is well-documented that an early diagnosis leads to a better visual outcome. […] The currently recommended strategies are a combination of medication, lifestyle changes, and weight loss in the vast majority of patients.

• #59 Pseudotumor cerebri (idiopathic intracranial hypertension) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudotumor-cerebri/diagnosis-treatment/drc-20354036

  To diagnose your condition, your doctor will review your symptoms and medical history, conduct a physical examination, and order tests. […] If pseudotumor cerebri is suspected, a doctor trained in eye conditions (ophthalmologist) will look for a distinctive type of swelling affecting the optic nerve in the back of your eye. […] Your doctor is likely to order an Magnetic resonance imaging (MRI) or computed tomography (CT) scan. These tests can rule out other problems that can cause similar symptoms, such as brain tumors and blood clots. […] Your doctor might order a lumbar puncture to measure the pressure inside your skull and analyze your spinal fluid. […] If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure might be necessary.

• #60 Intracranial Hypertension (Pseudotumor Cerebri): Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/intracranial-hypertension-pseudotumor-cerebri

  If treated, the outcome is good. If not treated, permanent blindness can occur. Unfortunately, up to one in 10 people with intracranial hypertension have some vision loss. Treatment typically lasts six to 12 months. With treatment, in most cases, this condition goes away. However, increased pressure can return months or even years later. You can reduce this risk by helping your child maintain a healthy weight. It is important to have regular eye exams to check for vision loss even after the intracranial hypertension gets better.

• #61 Idiopathic Intracranial Hypertension – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/idiopathic-intracranial-hypertension/

  In patients with obesity, weight loss is the main treatment for IIH. […] One of the first steps to treating IIH is reviewing the patients medication and vitamin list. Any medications or vitamins linked to IIH may be stopped. […] Many times, the treating physician will prescribe a medication called acetazolamide. Acetazolamide reduces the amount of cerebral spinal fluid that the brain produces. This then reduces the pressure within the brain. […] Symptoms can last for months or years in some patients and be life-long in others. With treatment, there is typically a gradual improvement in vision with minimal, if any, vision loss. Cases where vision loss is significant or permanent are uncommon in IIH. […] IIH can appear again months or years after treatment. It is important for patients to have yearly follow-up eye exams.

• #62 Intracranial Hypertension (Pseudotumor Cerebri): Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/intracranial-hypertension-pseudotumor-cerebri

  If treated, the outcome is good. If not treated, permanent blindness can occur. Unfortunately, up to one in 10 people with intracranial hypertension have some vision loss. Treatment typically lasts six to 12 months. With treatment, in most cases, this condition goes away. However, increased pressure can return months or even years later. You can reduce this risk by helping your child maintain a healthy weight. It is important to have regular eye exams to check for vision loss even after the intracranial hypertension gets better.

• #63 Idiopathic Intracranial Hypertension – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/idiopathic-intracranial-hypertension/

  In patients with obesity, weight loss is the main treatment for IIH. […] One of the first steps to treating IIH is reviewing the patients medication and vitamin list. Any medications or vitamins linked to IIH may be stopped. […] Many times, the treating physician will prescribe a medication called acetazolamide. Acetazolamide reduces the amount of cerebral spinal fluid that the brain produces. This then reduces the pressure within the brain. […] Symptoms can last for months or years in some patients and be life-long in others. With treatment, there is typically a gradual improvement in vision with minimal, if any, vision loss. Cases where vision loss is significant or permanent are uncommon in IIH. […] IIH can appear again months or years after treatment. It is important for patients to have yearly follow-up eye exams.

• #64 Diagnosis and medical management of idiopathic intracranial hypertension – Clinical Tree

  https://clinicalpub.com/diagnosis-and-medical-management-of-idiopathic-intracranial-hypertension/

  Idiopathic intracranial hypertension is characterized by idiopathic elevation of ICP, with other possible causes of elevated ICP ruled out before the diagnosis. […] The modified Dandy criteria is a set of diagnostic criteria designed to guide the diagnosis of IIH and serves as an outline for this chapter, listed in Table 16.1. […] To complete the evaluation of a patient with suspected IIH, the following diagnostic workup must be completed. […] Complete ocular examination Formal visual field testing Optical coherence tomography MRI of the brain, with and without contrast MRV of the head Neurological examination LP with opening pressure and CSF analysis.

• #65 The diagnosis and management of idiopathic intracranial hypertension and the associated headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4916517/

  The target of IIH management is to reduce ICP with the main goals of preservation of vision and relief of headache. […] The first drug of choice in IIH management is acetazolamide, an old diuretic with a significant carbonic anhydrase inhibitor effect. […] The effect of topiramate and acetazolamide was compared in an open-label study of 40 IIH patients, with a main focus on visual fields. […] Although headache is the most frequent symptom in patients with IIH, headache management is a field yet to be explored, since the existing treatment trials have been focused on ICP changes or visual outcome rather than a headache relief. […] In many patients IIH headache responds well to management of ICP by cerebrospinal fluid withdrawal or medical treatment, with most improvement occurring within the first month.

• #66 Managing idiopathic intracranial hypertension in the eye clinic | Eye

  https://www.nature.com/articles/s41433-024-03140-y

  A lumbar puncture (LP) is then a recommended investigation. […] The opening pressure should be recorded, and above 25cm of water (H2O) is considered abnormally high. […] A definite diagnosis of IIH was made as per the diagnostic criteria. […] The main principles of treatment of IIH are to protect vision, treat the underlying cause, and reduce headache morbidity. […] The use of acetazolamide, a carbonic anhydrase inhibitor, is the most widespread treatment currently used to treat IIH to help with reduction of ICP and to protect the vision. […] In 2014 the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) provided evidence that acetazolamide, in association with weight loss, was effective in reducing ICP and improving papilloedema in patients with mild to moderate visual field changes.

• #67 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  Idiopathic intracranial hypertension (IIH) is increased pressure in your skull. It occurs because of cerebrospinal fluid buildup around your brain. The cause is unknown. Treatments are available. […] To diagnose IIH, a healthcare provider will take your medical history and perform a physical exam. Theyll learn more about what symptoms you experience and order several diagnostic tests to rule out conditions with similar symptoms. Tests may include: Eye exam with a visual field test to check for blind spots in your vision, Brain CT scan or MRI, Spinal tap (lumbar puncture). […] The goals of IIH treatment are to decrease pressure on your brain and prevent vision loss. Depending on the severity, your healthcare provider may recommend: Taking medications, Undergoing surgery, Weight management. […] Timely treatment at the first sign of vision changes or symptoms can help reduce your risk of complications like permanent vision loss. Treatment is often successful at relieving symptoms. Your healthcare provider can give you the best information on what you can expect in your situation.

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