Epidemiology


Predominantly affects obese women aged 15–44 years

Etiology


  • Risk factors
    • Female sex
    • Obesity
    • Certain medications (drug-induced intracranial hypertension), including:

Pathophysiology


  • A mismatch between production and resorption of CSF (cause unknown) → ↑ ICP → damage to structures of the CNS and especially to the optical nerve fibers
  • Orthograde axoplasmic flow stasis at the optic nerve head leads to bilateral papilledema.

Clinical features


  • Diffuse headaches
  • Visual symptoms
    • Transient vision loss
  • Pulsatile tinnitus (swishing sound)
  • Cranial nerve disorders (especially CN VI → diplopia)
  • No cognitive impairment

Diagnostics


  • Ophthalmologic examination
    • Ophthalmoscopy: bilateral papilledema
    • Visual field test may show an enlarged blind spot and peripheral loss of vision
  • Normal CT scan of head
  • MRI: with contrast and MR venography (MRV)
    • To rule out other causes of increased ICP
    • Shows
      • Unremarkable brain parenchyma
  • Lumbar puncture (LP)
    • Elevated opening pressure > 20 cm H2O

Treatment