- Headache caused by raised ICP – due to impaired CSF absorption from the subarachnoid space across the arachnoid villi into the dural sinuses.
- Typically obese women of child bearing age
- Risks
- Women
- Cushings
- weight gain
- medications (COCP, Vitamin A, withdrawal corticosteroids, lithium, tetracyclines)
- Clinical
- Headache
- it is worst first thing in the morning and last thing at night, and relieved on standing – consistent with raised intracranial pressure
- eye movement worsens Headache
- gradual visual field defects
- due to effects of raised intracranial pressure on cranial nerves
- gross bilateral papilloedema
- without significant focal intracranial signs
- severity is associated with risk of visual loss
- vomiting, drowsiness
- Pulsatile Tinnitus – Unilateral or bilateral “whooshing” sound
- Nausea
- Back pain
- Investigation
- MRI – Preferably with MRV to rule out intracranial lesions, sinus thrombosis
- Lumbar puncture
- Measure opening pressure
- Following neuroimaging to rule out lesion
- Diagnostic criteria
- No alternative diagnosis on CT/MRI
- Opening pressure > 25 cm H2O in lateral position
- Symptoms and signs of raised ICP – papilledema or 6th nerve palsy
- No other neurological signs aside from 6th nerve palsy
- Normal makeup of CSF
- Complications
- Can cause blindness, persistent headaches
- Treatment
- Multidisciplinary – neurology, ophthal, neurosurg
- Urgent referral to neurology/ED
- Acetazolamide – reduces CSF production
- Document/measure optic nerve and visual fields – serial examinations
- Allied health – weight loss
- CSF shunt
- Stop contributing medications
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