Idiopathic Intracranial Hypertension (IIH)

What is Idiopathic Intracranial Hypertension (IIH)

Idiopathic intracranial hypertension (IIH) is a condition that increases pressure around the brain.

The fluid that surrounds the brain and spinal cord (cerebrospinal fluid, CSF) increases and causes the pressure. Idiopathic means that the cause of this condition is not known.

IIH affects the brain and spinal cord (is a neurological disorder). If this condition is not treated, it can cause vision loss or blindness.

5 Interesting Facts of Idiopathic Intracranial Hypertension

1. Occurs most frequently in obese people
2. Typically involves headache with pulsatile tinnitus, transient visual obscurations, and double vision (diplopia); papilledema may develop
3. Most notable finding during physical examination is bilateral optic disk edema
4. Lumbar puncture and cerebrospinal fluid analysis are indicated when CT or MRI excludes presence of a space-occupying lesion or other diagnosis
   • Lumbar puncture results reveal elevated intracranial pressure
   • Cerebrospinal fluid analysis results are within reference range
5. Differentiated based on history, physical examination, and lumbar puncture with cerebrospinal fluid analysis

What increases the risk?

You are more likely to develop this condition if:

• You are severely overweight (obese).
• You are a woman who has not gone through menopause.
• You take certain medicines, such as birth control or steroids.

What are the symptoms of Idiopathic Intracranial Hypertension?

Symptoms of Idiopathic Intracranial Hypertension include:

• Headaches. This is the most common symptom.
• Pain in the shoulders or neck.
• Nausea and vomiting.
• A “rushing water” or pulsing sound within the ears (pulsatile tinnitus).
• Double vision.
• Blurred vision.
• Brief episodes of complete vision loss.

How is Idiopathic Intracranial Hypertension diagnosed?

Idiopathic Intracranial Hypertension may be diagnosed based on:

• Your symptoms.
• Your medical history.
• CT scan of the brain.
• MRI of the brain.
• Magnetic resonance venogram (MRV) to check veins in the brain.
• Diagnostic lumbar puncture. This is a procedure to remove and examine a sample of cerebrospinal fluid. This procedure can determine whether too much fluid may be causing IIH.
• A thorough eye exam to check for swelling or nerve damage in the eyes.

How is this treated?

Treatment for this condition depends on your symptoms. The goal of treatment is to decrease the pressure around your brain. Common treatments include:

• Medicines to decrease the production of spinal fluid and lower the pressure within your skull.
• Medicines to prevent or treat headaches.
• Surgery to place drains (shunts) in your brain to remove excess fluid.
• Lumbar puncture to remove excess cerebrospinal fluid.

Follow these instructions at home:

• If you are overweight or obese, work with your health care provider to lose weight.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking medicines that can make you sleepy.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have changes in your vision, such as:
  • Double vision.
  • Not being able to see colors (color vision).

Get help right away if:

• You have any of the following symptoms and they get worse or do not get better.
  • Headaches.
  • Nausea.
  • Vomiting.
  • Vision changes or difficulty seeing.

Summary

• Idiopathic intracranial hypertension (IIH) is a condition that increases pressure around the brain. The cause is not known (is idiopathic).
• The most common symptom of IIH is headaches.
• Treatment may include medicines or surgery to relieve the pressure on your brain.