A Practical Approach To, Diagnosis, Assessment and Management Of
REVIEW A practical approach to, diagnosis, Pract Neurol: first published as 10.1136/practneurol-2014-000821 on 8 May 2014. Downloaded from assessment and management of idiopathic intracranial hypertension Susan P Mollan,1 Keira A Markey,2 James D Benzimra,1 Andrew Jacks,1 Tim D Matthews,1 Michael A Burdon,1 Alex J Sinclair2,3 1Birmingham Neuro- ABSTRACT term to encompass primary raised intra- Ophthalmology Unit, Adult patients who present with papilloedema cranial pressure where there is no identi- Ophthalmology Department, — — University Hospitals Birmingham and symptoms of raised intracranial pressure fiable cause which we term IIH and 3 NHS Trust, Queen Elizabeth need urgent multidisciplinary assessment secondary causes of raised pressure. Hospital Birmingham, including neuroimaging, to exclude life- The diagnostic criteria of IIH are well Birmingham, UK 2 threatening causes. Where there is no apparent known and have evolved since Dandy’s Neurotrauma and 4 Neurodegeneration, School of underlying cause for the raised intracranial initial description in 1937 ; they include Clinical and Experimental pressure, patients are considered to have a CSF opening pressure of ≥25 cm H2O Medicine, College of Medical idiopathic intracranial hypertension (IIH). The (box 1).3 However, these criteria recom- and Dental Sciences, The incidence of IIH is increasing in line with the mend imaging only to exclude a venous Medical School, The University of Birmingham, Birmingham, UK global epidemic of obesity. There are sinus thrombosis in patients without the 3Department of Neurology, controversial issues in its diagnosis and typical IIH phenotype (obesity and University Hospital Birmingham management. This paper gives a practical female sex). We feel, however, that it is NHS Trust, Queen Elizabeth Hospital Birmingham, approach to assessing patients with essential to exclude venous sinus throm- Birmingham, UK papilloedema, its investigation and the bosis (using MRI or CT with venography) subsequent management of patients with IIH.
[Show full text]