Epidemiology

Predominantly affects obese women aged 15–44 years

Etiology

• Risk factors
  • Female sex
  • Obesity
  • Certain medications (drug-induced intracranial hypertension), including:
    • Growth hormone
    • Tetracyclines
    • Excessive vitamin A or derivatives
    • Danazol

Pathophysiology

• A mismatch between production and resorption of CSF (cause unknown) → ↑ ICP → damage to structures of the CNS and especially to the optical nerve fibers
• Orthograde axoplasmic flow stasis at the optic nerve head leads to bilateral papilledema.

Clinical features

• Diffuse headaches
• Visual symptoms
  • Transient vision loss
• Pulsatile tinnitus (swishing sound)
• Cranial nerve disorders (especially CN VI → diplopia)
• No cognitive impairment

Diagnostics

• Ophthalmologic examination
  • Ophthalmoscopy: bilateral papilledema
  • Visual field test may show an enlarged blind spot and peripheral loss of vision
• Normal CT scan of head
• MRI: with contrast and MR venography (MRV)
  • To rule out other causes of increased ICP
  • Shows
    • Unremarkable brain parenchyma
• Lumbar puncture (LP)
  • Elevated opening pressure > 20 cm H2O

Treatment