The diagnosis and management of idiopathic intracranial hypertension and the associated headache

Abstract

Idiopathic intracranial hypertension (IIH) is a challenging disorder with a rapid increasing incidence due to a close relation to obesity. The onset of symptoms is often insidious and patients may see many different specialists before the IIH diagnosis is settled. A summary of diagnosis, symptoms, headache characteristics and course, as well as existing evidence of treatment strategies is presented and strategies for investigations and management are proposed.

Stabbing Headache as the Presenting Symptom of Idiopathic Intracranial Hypertension

“…Aggravation of headache by coughing or straining and relief after CSF withdrawal are reported by most patients. The former criteria of International Classification of Headache Disorders (ICHD) were not specific for the headache in IIH and the current revised ICHD‐3 beta diagnostic criteria markedly improved clinical applicability and increased sensitivity and specificity . The headache of our patient, which developed in temporal relation with IIH, led to its discovery and was relieved by reducing intracranial pressure, fulfilled these criteria although being rather atypical in the form of unilateral SH.…”

“…IIH is characterized by increased intracranial pressure in the absence of a structural brain lesion or any identifiable reason, presenting mainly with headache and visual symptoms . The most frequent IIH‐related headache types are in the form of tension type headache, migraine without aura or both …”

Optic Neuropathy in Idiopathic Intracranial Hypertension

“…3) Proposal of a stratified treatment strategy for idiopathic intracranial hypertension according to symptom severity. (31) …”

Empty Sella and Sagittal Sinus Thrombosis in a Woman with Subaortic Stenosise

“…Secondary IH (SIH) may be due to tumor, infection, obstruction of CSF flow, and arteriovenous fistula [1][2][3][6][7][8][9][10]. CVT cab be confirmed by images of triangle and empty delta signs, and loss of flow void [1,10,11]. CVTs are less common than arterial thromboses, but under diagnosis occur without imaging evaluations; arterial stroke and other benign and malignant disorders are differential diagnosis [1][2][3].…”

“…The sella turcica may be partially or totally filled with cerebrospinal fluid and the hypophysis is compressed; in cases of shrinking or flattening of the gland, Magnetic Resonance (MR) study can show the sella appearing totally or partially empty -the empty sella syndrome [3,4,[6][7][8][9][10][11][12][13]. This condition may be related to SIH or Idiopathic IH (IIH), but the gland volume has no correlation with Intracranial Pressure (ICP) [3,4,9].…”