6. Evaluation of Elevated Intracranial Pressure

Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

Pseudotumor cerebri syndrome occurs when there is raised intracranial pressure but no known etiology.

These patients present with headaches that are typically worst in the morning when they wake up or when they are lying down. Some other symptoms can include transient vision loss, diplopia, pulsatile tinnitus, nausea, or vomiting. Idiopathic intracranial hypertension (IIH) predominately affects overweight women of childbearing age.

This disorder needs to be rigorously monitored to ensure the ICP is not elevating to levels dangerous enough to cause visual loss. Neurology consult and lumbar puncture are recommended after brain imaging to rule out any brain abnormalities. Treatment with a lumbar puncture to remove excess CSF has been shown to significantly reduce the mean ONSD, indicating that this procedure can lower the ICP to normal values.

Pseudotumor Cerebri (Idiopathic Intracranial Hypertension) Ultrasound Findings

On ocular ultrasound, you will find elevated ONSD measurements > 5 mm. Because this is typically a chronic condition, patients often have signs of Papilledema with optic disc bulging/elevation.

Papilledema Illustration
Pseudotumor Cerebri Ocular Ultrasound Optic Disc Bulging elevation Papilledema
Papilledema on Ocular Ultrasound

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