IDIOPATHIC INTRACRANIAL

HYPERTENSION

BY JENISE BROADHEAD
WHAT IS IDIOPATHIC INTRACRANIAL HYPERTENSION?

 This condition causes the

overproduction of cerebrospinal fluid
(CSF) and causes pressure in the skull.
The symptoms usually mimic those of a
brain tumor.
WHAT ARE THE SYMPTOMS?
 A clinical study that was published in
the International Archives of
Intergraded Medicine was conducted Common Symptoms
with 50 patients.
Symptoms
 Out of those 50 patients, headaches
were the most common symptom. All
50 patients reported a reoccurring
headache.
 38 out of 50 patients have 50
experienced double vision (diplopia). 30
38

 30 patients reported some sort of 20

visual disturbance. Head ache Vi sual di st ur b ances T i n ni t us Di pl o pi a

 20 patients experienced ringing or
whooshing in the ear (tinnitus).
PAPILLEDEMA

 While it is possible to have IIH and no

papilledema, it is common to have
papilledema due to IIH.
 Papilledema is the swelling of the optic nerve
due to increased intracranial pressure.
 Papilledema can be present without affecting
vision, but it may cause some visual
disturbances such as flickering vision, double
vision, and vision loss.
 Papilledema can result from a brain injury or
tumor as well as IIH.
PAPILLEDEMA (CONTINUED)

 In the same clinical study that was Papilledema

published in the International Archives of Column2

Integrated Medicine, an examination was

done to check the optic nerve.
 38 patients were discovered to have
bilateral papilledema (papilledema in
both eyes). 38

 10 patients only had papilledema in the

right eye 10
 4 patients only had papilledema in the left Bi l at er al P ap i l l ed em a P ap i l l edem a ( Ri g ht eye
4
P api l l edem a ( L ef t ey e
eye. o nl y) on l y)
LATERAL RECTUS PALSY

 Lateral Rectus Palsy is when there is

limited outward movement of the eye.
Horizontal double vision can also
occur when looking to the side.
 Lateral Rectus Palsy can be caused by
many things, such as tumors, middle
ear infections, swelling of blood
vessels around the eye, as well as
increased intracranial pressure.
LATERAL RECTUS PALSY (CONTINUED)

 Out of the same 50 patients that were

previously tested, 22 in total had some form of LATeral Rectus Palsy
lateral rectus palsy. Column2

12
 3 patients had rectus palsy in both eyes.

7
 7 patients had only the left eye affected.
 12 patients were discovered to have had their

3
right eyes affected. Bi l at er al r ect us L at er al Rect u s P al sy L at er al Rect us P al sy
p al sy ( L ef t E y e On l y) ( Ri g ht E y e Onl y)
WHO CAN BE AFFECTED?

 A study conducted by the Post Graduate

Sex and IIH
Institute of Medical Education and Research
Male
had a group of 721 patients all with diagnosed 9%
IIH. While the majority of patients were
females in their childbearing years, males were
still affected.
 Males with IIH show symptoms differently than
females. Males were twice as likely to develop
visual loss as females. Female
91%
 IIH can occur at any age, but typically the
symptoms start as a young adult.
 HOW IS IT CAUSED?

 IIH is idiopathic, which means researchers don’t know why it occurs in some people.
There are, however, some medications that may increase the risk of developing IIH.
Those medications include:
 Birth Control Pills
 Chemotherapy Drugs
 Steroids
 Acne Medications.
IS THERE TREATMENT?

 There are a few ways to treat IIH. There are

medications such as Diamox and Topiramate.
 In more severe cases, to prevent the patient from
going blind, a shunt will be placed either in the brain
or in the spine to relieve some of the pressure.
 Weight loss can also aid in the treatment of IIH, but
it may not completely cure it.
 Lumbar punctures (spinal tap) can be done to help
reduce the cerebrospinal fluid (CSF) temporarily.
MEDICATION

 Acetazolamide (Diamox) is the most common medication

prescribed to help lower CSF fluid in the skull. A treatment study
was done by Andrew Lee and Michael Wall with 36 patients.
Headaches, papilledema, and increased CSF were reported by 26
of the 36 patients. Acetazolamide was 47-67% successful in
reducing symptoms.
 Topiramate is another option for medication. Topiramate helps
treat migraines and it also aids in weight loss. Topiramate and
Acetazolamide work about the same when it comes to reducing
symptoms.
LUMBOPERITONEAL SHUNT

Symptoms after the lumboperitoneal shunt

 The University of Copenhagen did a study 40
with 53 patients. They got surgery at the 35
base of their spine to relieve some of the 30
CSF pressure. 25
 The patients went back to the doctor for 20

their 6-month follow-up. Many patients 15

reported a reoccurring headaches. Patients 10

reported no increase in other symptoms 5

such as tinnitus and diplopia. 0

Headache Tinnitus Diplopia
(Unchanged) (Unchanged)

Column2
 BRAIN SHUNT

 Brain shunts are required to manage

symptoms if patients fail medical
Results of Brain Shunts
management. In this study done by 56
Cambridge University Hospitals, all patients 52
had IIH and papilledema. 48

 26 patients received a ventriculo-peritoneal 44

40
shunt. Papilloedema Improved Visual Improved
Resolution Acuity Headaches
 1 patient received a ventriculo-atrial shunt.
 26 patients got an Orbis Signa Valve. Column1

 2 patients got a Strata Valve.

 The follow-up appointments show that there
was substantial improvement in all patients.
WEIGHT LOSS

 Weight loss can help significantly reduce symptoms, but it might not be
a cure-all. A study at the University of Copenhagen was done with a
very small number of patients. They were given an extremely low-
calorie diet of about 425 calories per day with very low to no sodium.
After three months, around 15% of each patients' total body weight was
lost. Many patient’s symptoms were reduced, such as headaches and
papilledema.
 Patients that need immediate weight loss so vision is not lost can get
bariatric surgery. 62 patients reported that their symptoms were 92%
resolved, and 34 out of 35 patients' papilledema regressed dramatically.
LUMBAR PUNCTURE
 Lumbar puncture is when a needle is inserted into the spinal
canal to collect CSF.
 The University of Birmingham did a study to see if lumbar
punctures would help reduce the CSF pressure.
 52 patients participated in this study and had opening pressures
ranging from 28 to 37 cm CSF. Normal opening pressures are 7-
18 cm CSF.
 A week after the procedure was done, the headache severity was
reported to have improved by about 71%.
 This is a temporary way to get relief if the headaches are too
much to handle.
WHAT HAPPENS IF LEFT UNTREATED?

 If IIH is left untreated, there will be an increased risk

of vision loss. If papilledema is left untreated and the
optic nerve gets damaged, then the patient will most
likely have permanent vision loss or go completely
blind. On top of the vision issues, the headache,
tinnitus, and diplopia will not go away unless the
patient is treated.
SUMMARY

 IIH is a rare disease that can cause severe headaches and vision loss.
 There are multiple options for treatment, such as medication, weight loss, and surgery
to get either a shunt in your brain or spine.
 Women in their childbearing years are the majority of patients, but men can also have
this condition.
 Taking certain medications can increase the risk of developing IIH.
 IIH is not life-threatening, but if left untreated, there is a possibility of total vision
loss.
 STATEMENT OF GOALS AND CHOICES
 The purpose of this evaluation is to educate people who know little about the condition IIH. That could be someone that is
newly diagnosed or a friend or family member who just doesn’t understand what the condition entails. What this evaluation
is doing is laying out data from clinical studies to educate others about what this condition entails. The audience should have
enough information to understand the symptoms and treatment options for this condition. The intended audience would be
people that have IIH, people that have never heard of it, or don’t understand it. I hope the individuals that do not have this
condition will be educated on this rare condition. This condition is not something to take lightly. A lot more goes into it, and
there are risk factors that can result in blindness. The people with IIH that would read this evaluation would have first-hand
knowledge of how this condition feels. My friend group does not think this condition is to be taken seriously. They say to
take ibuprofen and the symptoms will go away. They would be a fantastic group to show this evaluation to. They would be
able to see all the symptoms, risk factors, and treatment options that go along with this condition. Hopefully, by the end of
this evaluation, they will have a little more of an understanding of how this condition works and that symptoms don’t simply
go away; they must be treated. For the ones who don’t understand it, like my friend group, they would need the motivation
to learn and understand this condition, such as from a friend or family member that was diagnosed. The rhetorical choices
that were made were logos and bulleted lists. Logos was used to appeal to the audience in a logical way to educate them.
Bulleted lists were used to make the information easier for the audience to read.
REFERENCES

 Bjornson, A., Tapply, I., Nabbanja, E., Lalou, A.-D., Czosnyka, Z., Muthusamy, B., & Garnett, M. (n.d.). Ventriculo-peritoneal shunting is a safe and effective treatment for
idiopathic intracranial hypertension. British journal of neurosurgery. Retrieved October 19, 2021, from https://pubmed.ncbi.nlm.nih.gov/30653369/. 
 Etminan, M., Luo, H., & Gustafson, P. (2015, June). Risk of intracranial hypertension with intrauterine levonorgestrel. Therapeutic advances in drug safety. Retrieved October 19,
2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519742/. 
 Jensen, R. H., Radojicic, A., & Yri, H. (2016, July). The diagnosis and management of idiopathic intracranial hypertension and the associated headache. Therapeutic advances in
neurological disorders. Retrieved October 19, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916517/. 
 Raoof, N., & Hoffmann, J. (2021, April). Diagnosis and treatment of idiopathic intracranial hypertension. Cephalalgia : an international journal of headache. Retrieved October
19, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020303/#bibr4-0333102421997093. 
 Takkar, A., & Lal, V. (2020). Idiopathic intracranial hypertension: The monster within. Annals of Indian Academy of Neurology. Retrieved October 19, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061511/. 
 Wall, M. (2010, August). Idiopathic intracranial hypertension. Neurologic clinics. Retrieved October 19, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908600/. 
 Wall, M., & Lee, A. G. (n.d.). Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment. UpToDate. Retrieved October 19, 2021, from
https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment. 
 Yiangou, A., Mitchell, J., Markey, K. A., Scotton, W., Nightingale, P., Botfield, H., Ottridge, R., Mollan, S. P., & Sinclair, A. J. (2019, February). Therapeutic lumbar puncture for
headache in idiopathic intracranial hypertension: Minimal gain, is it worth the pain? Cephalalgia : an international journal of headache. Retrieved October 26, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376596/.