Idiopathic Intracranial Hypertension (IIH) is a disorder that occurs when the cerebrospinal fluid (fluid surrounding the spinal cord and brain) abnormally builds up and causes a pressure increase in the skull. The cerebrospinal fluid (CSF) is responsible for nourishing the brain and spinal cord and removing impurities.
On ordinary occasions, the CSF is reabsorbed through the blood vessels into the body. However, the fluid may become too much, or there may be a dysfunction in its reabsorption leading to the build-up that impacts the optic nerve, causing problems with vision.
IIH can affect two groups of children; prepubescent and teenagers. In prepubescent children, the occurrence is mainly secondary, and it affects both males and females. On the other hand, the development of the condition in teenagers is usually linked to weight gain and obesity.
Also Known As
- Pseudotumor Cerebri
- Benign intracranial hypertension
There are three categories:
Causes & Risk Factors
Experts are still not aware of IIH causes, but the acute and chronic types have suspected causes. Acute IIH has a sudden occurrence of symptoms, often due to a head injury or stroke. Symptoms in chronic IIH develop over time and may be due to underlying health conditions.
The standard explanation for elevated pressure is a problem of fluid reabsorption into the body. The condition can affect any child, but some people have a higher risk than others. Some of the factors that increase the risk of developing IIH include:
- Obesity - Excess weight is the most significant risk factor.
- Medication - Examples are lithium, tetracycline, a lot of vitamin A, certain steroids, and birth control pills.
- Being female
- Blood vessel irregularities, especially those that come from birth, such as a narrowed vein that channels out blood and CSF from the brain resulting in elevated pressure in the skull.
- A sleep disorder known as sleep apnea
- Chronic kidney failure or thyroid condition
Signs & Symptoms
The symptoms of IIH are similar to those of brain tumors. Therefore, one should be careful not to receive a misdiagnosis. The most common symptoms are blurred vision and headaches. Other symptoms are:
- Vision problems which evolve slowly over time. Experiencing episodes of vision blurring. With a continued increase in pressure, a constant double vision arises until there is a risk of blindness.
- Trouble walking
- Seeing light flashes
- Dizziness, vomiting, and nausea
- Insistent ringing in the ears, tinnitus (a whooshing sound that pulses with heartbeat)
- Shoulder, neck, and back pain
An ophthalmologist will carry out a diagnosis to rule out other health problems such as brain tumors. The ophthalmologist will first inquire about the patient’s symptoms and medical history then carry out physical examinations and tests. Tests and exams will include:
- Eye exams - The ophthalmologist will look for prominent swelling of the optic nerve when IIH is suspected. The doctor will also perform visual field tests to check for blind spots.
- Brain imaging which entails MRI or CT scans
- Lumbar puncture may be performed to check the pressure and rule out infectious or inflammatory causes of increased pressure
Treatment is dependent on the causes of fluid build-up in the skull. The treatment may be home care practice, medical therapy, or surgery.
The doctor may prescribe drugs that reduce symptoms. Acetazolamide, for instance, helps to reduce the production of cerebrospinal fluid. Other diuretics may also be combined with it if it is not sufficient on its own. Migraine medication may also be prescribed to reduce severe headaches.
Surgery may be done when the patient’s vision worsens, and it may entail:
- A spinal tap that aims to remove fluid and minimize pressure
- Surgery that decompresses increased CSF around the optic nerve
- Spinal fluid shunt
- Venous sinus stenting. Where there is a narrowed venous sinus, a stent is placed to enhance CSF absorption and decrease pressure in the skull
Reduction of salt intake is a good form of weight shedding. Therefore, obese patients should embrace a low sodium weight-loss diet. The doctor may also assist in enrolling the patient to a weight loss program.
Prognosis & Long-Term Outlook
Up to date, there have been no studies that show the natural history of the disease. After treatment, there is usually improvement, or the disease may stabilize. Many patients do not recover fully, and about 8 to 38% of patients may have the disease weeks or years after recovery. An increase in weight is associated with the recurrence of the disease.
If IIH is not treated, it may lead to permanent vision loss. Therefore, patients should have regular check-ups to help monitor symptoms.
Prevention & Follow Up
As heavy weight has been linked to IIH, adopting a healthy and low diet lifestyle is encouraged to reduce the risks of developing the condition. Regular workout and exercises are also helpful.