Summary about Disease
Benign intracranial hypertension (BIH), also known as idiopathic intracranial hypertension (IIH) or pseudotumor cerebri, is a condition characterized by increased pressure around the brain (intracranial pressure) in the absence of a tumor or other identifiable cause. The elevated pressure can lead to headaches, vision problems, and other neurological symptoms. The term "benign" can be misleading as, if left untreated, it can cause permanent vision loss.
Symptoms
Headache: Often the most common symptom, described as a throbbing headache that can worsen with straining.
Vision problems: Blurred vision, double vision (diplopia), temporary vision loss (transient obscurations), blind spots, and eventually permanent vision loss.
Tinnitus: Pulsatile tinnitus (a whooshing sound in the ears that beats in time with your pulse).
Neck, shoulder, or back pain.
Nausea and vomiting.
Dizziness.
Papilledema: Swelling of the optic disc, which can be seen during an eye exam.
Photopsia: Seeing flashes of light.
Causes
The exact cause of BIH is unknown, hence the term "idiopathic." However, several factors have been associated with the condition:
Obesity: Significantly more common in overweight or obese women of childbearing age.
Medications: Certain medications, such as tetracycline antibiotics, some birth control pills, and high doses of vitamin A, have been linked.
Medical conditions: Some conditions like sleep apnea, polycystic ovary syndrome (PCOS), and Addison's disease may be associated.
Venous Sinus Stenosis: Narrowing of the large veins that drain blood from the brain.
Medicine Used
Acetazolamide (Diamox): A carbonic anhydrase inhibitor that reduces the production of cerebrospinal fluid (CSF). This is often the first-line treatment.
Topiramate (Topamax): Can help reduce intracranial pressure and may also help with headaches.
Furosemide (Lasix): A diuretic that can help reduce fluid retention.
Pain relievers: Over-the-counter or prescription pain relievers may be used to manage headaches.
Is Communicable
No, benign intracranial hypertension is not a communicable disease. It is not contagious and cannot be spread from person to person.
Precautions
Weight management: Maintaining a healthy weight or losing weight if overweight/obese is crucial.
Medication review: Review medications with a doctor to identify any potential contributing factors.
Regular eye exams: Regular check-ups with an ophthalmologist to monitor for vision changes and papilledema.
Low-sodium diet: A low-sodium diet may help reduce fluid retention.
Avoid prolonged straining: Avoid activities that increase intracranial pressure, such as heavy lifting or prolonged straining.
How long does an outbreak last?
BIH is not an "outbreak" but a chronic condition. The duration of symptoms and the course of the disease vary greatly from person to person. Some individuals may experience a single episode that resolves with treatment, while others may have chronic symptoms that require ongoing management. Remission and relapse are possible.
How is it diagnosed?
Neurological exam: To assess reflexes, coordination, and cranial nerve function.
Eye exam: Including fundoscopy to check for papilledema.
MRI or CT scan of the brain: To rule out other causes of increased intracranial pressure, such as a tumor or hydrocephalus.
Lumbar puncture (spinal tap): To measure the CSF pressure. Elevated CSF pressure (typically >25 cm H2O) is a key diagnostic criterion. CSF is also analyzed to rule out infection or other abnormalities.
Visual field testing: To assess for blind spots or other visual deficits.
Timeline of Symptoms
The onset of symptoms can be gradual or more rapid.
Early stages: Headaches may be intermittent and mild. Vision changes might be subtle, such as transient blurring.
Progressive stages: Headaches become more frequent and severe. Vision problems worsen, including double vision, blind spots, and temporary vision loss. Tinnitus may develop.
Late stages (untreated): Permanent vision loss can occur. This timeline is variable, and some individuals may experience more rapid progression than others.
Important Considerations
Vision loss: The most serious complication of BIH is permanent vision loss. Early diagnosis and treatment are essential to prevent this.
Individual variability: The symptoms and severity of BIH can vary greatly. Treatment plans should be individualized.
Compliance with treatment: Adherence to prescribed medications and lifestyle modifications is crucial for managing the condition.
Monitoring: Regular follow-up appointments with a neurologist and ophthalmologist are necessary to monitor treatment effectiveness and detect any worsening of the condition.
Surgical options: In severe cases or if medical treatment is ineffective, surgical options like CSF shunting or optic nerve sheath fenestration may be considered.