Idiopathic Intracranial Hypertension

A.K.A. Pseudotumor Cerebri

1. Papilledema
2. Normal neurological examination except for cranial nerve abnormalities
3. Neuro-imaging:
   1. Normal brain parenchyma without evidence of hydrocephalus, mass, or structural lesion and no abnormal meningeal enhancement on MRI, with and without gadolinium, for typical patients (female and obese)
   2. MRI, with and without gadolinium, and MR venography for others.
   3. If MRI is unavailable or contraindicated, contrast-enhanced CT may be used
4. Normal CSF Composition
5. Elevated LP opening pressure (> 280 mm H20, 250 mm H20 if not sedated or obese)

1. Empty sella
2. Flattening of the posterior aspect of the globe
3. Distention of the perioptic subarachnoid space +/- o.n. tortuosity
4. Transverse venous sinus stenosis

• Headache
• Transient visual obscurations
• Pulse-synchronous tinnitus
• Binocular diplopia
• Neck, shoulder, or back pain
• Improvement of symptoms after lumbar puncture

Eye Rounds

Revised Diagnostic Criteria for the Pseudotumor Cerebri Syndrome in Adults and Children, Deborah I Friedman, MD Grant T. Liu, MD Kathleen B. Digre, MD, Presented at the North American Neuro-ophthalmology Society (NANOS) meeting, Snowbird, Utah, Feb. 12, 2013