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- The terms pseudotumor cerebri, benign intracranial hypertension, and idiopathic intracranial hypertension (IIH), are all synonymous terms which describe a condition of elevated intracranial pressure (ICP), but the latter is the preferred term of use.
- IIH almost ubiquitously presents with a generalized headache and papilledema (i.e. fundoscopic examination imperative!). Visual disturbance and non-specific symptoms such as dizziness may also be present.
- Elevated ICP and papilledema are clinical emergencies until the presence or absence of an intracranial mass is confirmed.
- The following conditions must be met in order to diagnose IIH:
- Non-focal neurologic examination (except for 6th nerve palsy in some cases)
- Elevated opening pressure on lumbar puncture, > 20 to 25 mmH2O (perform only after risk for herniation assessed!)
- Normal cytologic and chemical cerebrospinal fluid analysis
- Small, symmetric brain ventricles on neuroimaging
- Exclusion of other sources of IH such as venous sinus thromboses by obtaining an MRI/venographic study of the head
References
Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. Nov 26 2002;59(10):1492-5.