Lecture Notes

Overview

• Definition: Elevation of intracranial pressure (ICP) without an identifiable cause.
• Demographics: Primarily affects obese young women of childbearing age.
• Prevalence: Ranges from 0.5–2 per 100,000, increasing with the global rise in obesity.

Clinical Features

• Main Symptoms:

  • Headache: Frequently migrainous in phenotype; may persist after ICP normalization.
  • Visual Alterations: Papilledema-induced visual loss, transient visual obscurations (TVOs), diplopia.

  Visual Features of IIH

  1. Transient Visual Obscurations (TVOs):

     • Episodic visual clouding or loss (<1 minute).
     • Associated with postural changes and raised ICP-induced optic nerve ischemia.
     • Useful indicator of raised ICP.

  2. Diplopia:

     • Horizontal binocular diplopia due to sixth nerve palsy.
     • Third and fourth nerve palsies are rare.

  3. Visual Field Loss:

     • Common early sign: Enlarged blind spot, nasal defects, arcuate defects.
     • Visual acuity may remain unaffected in mild disease.

  4. Papilledema:

     • Bilateral optic disc swelling due to raised ICP.
     • Can result in optic atrophy and permanent visual loss if untreated.

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