Idiopathic intracranial hypertension without papilledema
J. Marcelis and S. D. Silberstein
Department of Internal Medicine, Temple University Hospital, Philadelphia, PA.
We describe 10 patients with idiopathic intracranial hypertension who did
not have papilledema. Idiopathic intracranial hypertension without
papilledema, although rarely reported, may well be a clinically important
headache syndrome. Historical and demographic features of patients with
idiopathic intracranial hypertension without papilledema are similar to
those of patients with papilledema. Obese women with chronic daily headache
and symptoms of increased intracranial pressure, pulsatile tinnitus,
history of head trauma or meningitis, an empty sella on imaging studies, or
a headache that is unrelieved by standard therapy should have a diagnostic
lumbar puncture. Findings from laboratory and neurologic investigations are
normal in most patients with idiopathic intracranial hypertension without
papilledema. Initial management should include removal of possible inciting
agents, weight loss if applicable, and standard headache therapy. Lumbar
puncture and diuretic therapy should precede a trial of corticosteroids.
Surgery (lumboperitoneal or ventriculoperitoneal shunt or perhaps optic
nerve sheath fenestration) may be indicated for prolonged incapacitating
headache that is not responsive to medical management or lumbar puncture.
Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional?
Killer et al.
Brain 2007;130:514-520.
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Bilateral transverse sinus stenosis predicts IIH without papilledema in patients with migraine
Bono et al.
Neurology 2006;67:419-423.
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Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations
Killer et al.
Br. J. Ophthalmol. 2003;87:777-781.
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Idiopathic intracranial hypertension: is papilloedema inevitable?
Wraige et al.
Arch. Dis. Child. 2002;87:223-224.
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Cerebral venous thrombosis and isolated intracranial hypertension without papilledema in CDH
Quattrone et al.
Neurology 2001;57:31-36.
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Idiopathic intracranial hypertension: any light on the mechanism of the raised pressure?
WALKER
J. Neurol. Neurosurg. Psychiatry 2001;71:1-5.
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Idiopathic Intracranial Hypertension in Children
Youroukos et al.
J Child Neurol 2000;15:453-457.
ABSTRACT
Benign intracranial hypertension: a non-thrombotic complication of the primary antiphospholipid syndrome?
Orefice et al.
Lupus 1995;4:324-326.
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