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benign raised idiopathic intracranial hypertension

Introduction

  • aka pseudotumor cerebri
  • a cause of chronic headache

Epidemiology

  • increasingly common

Aetiology / risk factors

  • most commonly occurs in overweight young women

Clinical features

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

Radiographic features on CT brain

  • slit-like ventricles
  • 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)

Diagnosis

  • confirmed with raised LP opening pressures

Mx

iich.1781750684.txt.gz · Last modified: 2026/06/18 02:44 by gary1

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