How is idiopathic intracranial hypertension (IIH) diagnosed?

The diagnosis of idiopathic intracranial hypertension (IIH) is suspected when a patient presents with headache, ringing in the ears, blurry or reduced vision, double vision and diminished vision when sitting up from a supine position.  Risk factors which predispose someone to developing IIH such as obesity, use of birth control pills, vitamin A products or certain antibiotics, are also important when considering the diagnosis.  If there is clinically a suspicion for IIH, the neurologist will perform an indepth examination looking for swelling of the optic nerve (within the eye) and an MRI brain to exclude other cause for increased pressure in the brain.  If the MRI brain is negative, a spinal tap is performed looking for increased pressure which confirms the diagnosis. 

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An evaluation for IIH will include the following:

  • A clinical exam
  • Imaging studies.Standard imaging studies are usually normal in IIH, however, the doctor may recommend this test to rule out other possible neurological conditions.
  • Examination of your visual fieldsby a highly trained neuro-ophthalmologist.
  • These exams will include:
    • Assessing your peripheral vision
    • Determining if you can distinguish different colors
    • Using an eye chart to test your central vision acuity (sharpness)
    • Dilation of the pupils (to examine the optic discs for swelling)
  • Performance of a spinal tap. This spinal tap will confirm the diagnosis by demonstrating a high pressure of cerebrospinal fluid (CSF)

If the neurologist or neuro-ophthalmologist confirms that you have IIH, he or she will recommend a very aggressive and urgent evaluation and treatment plan. If IIH is not treated immediately, permanent and lasting damage can occur to a patient's vision.

  • Medications (Diamox)
  • Weight loss
  • Stenting of narrowed cerebral venous sinuses
  • Placement of a permanent shunt in order to maintain the normal CSF pressure
  • Making an opening in the covering of the optic nerve to let the fluid out and relieve pressure on the nerve.

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