Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

Human brain, illustration
Human brain, illustration. SEBASTIAN KAULITZKI/Getty Images

Obesity has been found to have a number of effects on the brain. However, there is one rare condition in particular, known by its medical name, idiopathic intracranial hypertension (IIH), that is known to be caused by obesity and can be particularly dangerous.

What Is Idiopathic Intracranial Hypertension (IIH)?

IIH is also known as pseudotumor cerebri, and it is an obesity-related condition characterized by the following clinical features: headaches, papilledema (swelling of the optic nerve that supplies the eye), and vision loss.

These signs and symptoms are due to increased pressure inside the skull (cranium), with resulting pressure on the brain. Hence, the name: “idiopathic” means the exact cause is unknown; “intracranial” means inside the skull; and “hypertension” refers to increased pressure.

Who Gets IIH?

Ninety percent of cases occur in women of childbearing age who are obese. It can also occur during pregnancy. This condition is rarely seen in men or in children.

Obesity is a strong risk factor for IIH, or pseudotumor cerebri. Obesity is seen in 90 to 95% of IIH patients. And, with the obesity epidemic, rates of IIH cases have risen as well.

Other factors that are associated with IIH include certain drugs, such as corticosteroids, tetracycline and vitamin A (such as in the form of isotretinoin, which is used to treat severe acne).

What Are the Symptoms of IIH?

The main symptom of concern in IIH is a morning headache, which many patients describe as a dull, pressure-like sensation that gets worse upon coughing or straining (as with a bowel movement).

Almost all patients will experience loss of some peripheral vision, known as a peripheral visual field loss. There may be blind spots in the peripheral vision as well.

The majority of patients (approximately 60%) will also experience ringing in the ears (known as tinnitus). Some patients have double vision as well.

Serious Consequences of IIH

IIH can have some serious consequences. It can result in severe loss of vision that can be irreversible. This occurs in less than 10% of patients, however, and is twice as common in men as it is in women.

How Is It Treated?

Fortunately, IIH can be treated, particularly if it is caught early and before severe vision loss occurs. Treatment includes a low-sodium diet aimed at weight loss, the use of medications such as acetazolamide, and prevention of vision loss under the close care of a physician.

In about a quarter (25%) of cases, it can be helpful to drain off excess cerebrospinal fluid through a procedure known as a lumbar puncture (LP, also commonly known as a spinal tap).

Other procedures may be performed by an ophthalmologist to preserve vision in acute cases.

Medications can be given for the treatment of headaches if needed as well.

Sources

Galgano MA, Deshaies EM. An update on the management of pseudotumor cerebri. Clin Neurol Neurosurg. 2013;115:252-259.

Degnan AJ, Levy LM. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR 2011 32: 1986-1993.

Cotran et al. Robbins’ Pathologic Basis of Disease. 5th Edition. W.B. Saunders.

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