Idiopathic Intracranial Hypertension
What is Idiopathic Intracranial Hypertension (IIH)?
It is a brain disorder in which the pressure inside your skull (intracranial pressure) increases, causing headaches and vision deterioration. It is most common in obese women.
What are the Causes of IIH?
The exact cause of IIH is not clear. However, it may develop due to blockages in the veins of the brain or raised pressure within veins. CSF circulating the brain is normally absorbed back into the blood stream via veins. If there are blockages or high pressure in veins, this absorption does not occur effectively, leading to the accumulation of excess cerebrospinal fluid (CSF) inside the skull.
What are the Risk Factors for IIH?
People with the following conditions are at an increased risk for pseudotumor cerebri:
- Obesity/being overweight
- Kidney disorders
- Addison’s disease, a condition where your adrenal glands don’t produce the normal quantity of hormones
- Sleep apnea, a condition where you suffer from phases of stopped breathing during sleep
- Developmental abnormalities/ birth defects
- People using medications like steroids, birth control pills, tetracyclines (an antibiotic) and excess vitamin A are more susceptible to pseudotumor cerebri.
- COVID and COVID vaccines
What are the Symptoms of IIH?
The common symptoms of pseudotumor cerebri include:
- Severe headaches
- Vision problems like blurred vision, double vision or permanent loss of vision
- Ringing in your ears or pulsatile tinnitus
- Dizziness
- Pain in your back, neck, or shoulders
- Spontaneous leak of CSF from the nose or into the ear
How is IIH Diagnosed?
Your doctor will review your medical history and examine your symptoms. The following diagnostic tests are commonly ordered:
- Eye examination to check for swelling of the optic nerve at the back of your eye (papilledema)
- MRI scan to obtain a detailed image of your brain
- Venogram. Test performed to determine if there are blocked veins
- Lumbar puncture, also known as a spinal tap, to determine the pressure inside your skull. For this, your doctor will collect a fluid sample from the vertebrae in your back through a special needle.
What are the Treatments for IIH?
The different treatments to reduce or control the symptoms of IIH include:
Non-surgical Methods
- Drugs to reduce the production of cerebrospinal fluid in your brain
- Migraine medications to provide relief from headaches
- Diuretic medications to make you urinate more often and help relieve the pressure of body fluids overall, thereby reducing intracranial pressure.
- Repeated lumbar punctures to remove fluid
Surgical Methods
- Optic nerve sheath fenestration: In this procedure, the excess cerebrospinal fluid is drained by making a cut in the membrane around your optic nerve. This operation is done by an Ophthalmic surgeon.
- Venous stenting. This is performed if there are blockages in veins. A stent keeps the vein open. This procedure is performed by Intervention Neuro radiologists/surgeons.
- Ventriculoperitoneal shunt or lumboperitoneal shunt: In this procedure, a thin tube called a shunt is inserted in your brain or lower spine to allow drainage of the excess CSF from the brain into your abdomen.
Prevention of IIH
You can reduce your chances of developing a pseudotumor cerebri by:
- Maintaining a healthy weight.
- Consuming a nutritious diet that includes plenty of vegetables, fruits, and whole grains.
- Doing regular exercise, such as a daily brisk walk.
