Epidemiology
Predominantly affects obese women aged 15–44 years
Etiology
- Risk factors
- Female sex
- Obesity
- Certain medications (drug-induced intracranial hypertension), including:
- Growth hormone
- Tetracyclines
- Excessive vitamin A or derivatives
- Danazol
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