benign raised idiopathic intracranial hypertension

see also:

• headache
• raised intracranial pressure (ICP)

• aka pseudotumor cerebri
• a cause of chronic headache

• increasingly common

• most commonly occurs in overweight young women

• chronic headaches
• may have papilloedema
• some may develop thing of skull bone resulting in a CSF leak causing severe postural headaches

• slit-like ventricles
• empty sella syndrome (ESS)
• other radiologic features that are suggestive of this cause¹⁾:
  • optic nerve sheath distension
  • posterior globe flattening
  • optic nerve tortuosity in vertical or horizontal planes
  • papilledema/optic nerve head protrusion
  • optic nerve head enhancement
  • Meckel cave enlargement
  • arachnoid pits (aberrant arachnoid granulations) / small meningoceles, typically within the temporal bone and sphenoid wing
  • enlarged oculomotor cistern
  • prominent perivascular spaces
  • transverse sinus stenosis
  • acquired cerebellar tonsillar ectopia
  • increased subcutaneous fat thickness in the scalp and neck (a slim patient is unlikely to develop idiopathic intracranial hypertension)

• confirmed with raised LP opening pressures > 20mm water