Benign Intracranial Hypertension: A Reason for Headache in Women

Benign Intracranial Hypertension (BIH), also known as Idiopathic Intracranial Hypertension (IIH) or Pseudotumour Cerebri, is a neurological disorder characterized by raised intracranial pressure without the presence of a tumor, hydrocephalus, or other brain diseases. This condition arises due to impaired absorption of cerebrospinal fluid (CSF), which circulates around the brain and spinal cord. The term “idiopathic” is used because the exact reasons for impaired CSF absorption are unknown. BIH is common in obese women and can lead to significant visual impairment if left untreated. Prompt recognition and treatment are crucial to prevent potentially permanent vision loss.

Who is Affected?

BIH primarily affects women of childbearing age, especially those in their third or fourth decade of life. The Female:Male ratio ranges from 2:1 to 8:1, with up to 90% of patients being overweight. Women with menstrual irregularities are at an increased risk. Although less common, children can also be affected by this condition, often experiencing self-limiting symptoms.

Symptoms and Signs

The symptoms of BIH can vary, but common signs include:

– Generalized Throbbing Headache: Often occurring upon waking and relieved by taking an upright posture. The headache may be aggravated by coughing, straining, or changing body position.

– Visual Disturbances: Gradual visual loss, double vision, and short episodes of “wheel flashes” may occur. Severe cases can include nausea, vomiting, and drowsiness.

– Other Symptoms: Minor symptoms such as neck stiffness, dizziness, fatigue, and ataxia may also be present.

Certain medications (e.g., keprone and lindane), conditions (e.g., hypervitaminosis A, uraemia), steroid withdrawal, and the use of oral contraceptives have been associated with BIH.

Evaluation and Diagnosis

To diagnose BIH, several evaluations and diagnostic tests are performed:

– CT/MRI Studies: These imaging studies usually reveal normal or small-sized ventricles without any other intracranial abnormalities or masses.

– MR Venogram: Recommended to rule out thrombosis of cortical venous sinuses.

– Lumbar Puncture: This procedure measures the opening pressure of the cerebrospinal fluid (usually above 20 cm H2O, potentially up to 40) and helps rule out infections of the central nervous system.

– Neuro-ophthalmological Evaluation: Routinely performed to assess visual status and fields in patients diagnosed with BIH.

Treatment

BIH can sometimes resolve spontaneously within months or up to a year. Treatment options include:

– Medical Management:

– Lifestyle Changes: Fluid and salt restriction, weight reduction, and discontinuation of any offending drugs.

– Medications: Acetazolamide (Diamox) or diuretics like furosemide (Lasix) are commonly used. Steroids may be combined with these medications in some cases.

– Surgical Intervention: Necessary if symptoms are refractory to medical treatment, especially in patients with progressive visual loss due to raised intracranial pressure.

– Lumboperitoneal Shunt: The most common surgery, which diverts CSF into the abdominal cavity.

– Optic Nerve Sheath Fenestration: Performed for patients with visual deterioration due to persistent papilledema.

At Hannah Joseph Hospital, we are committed to providing comprehensive care for patients with Benign Intracranial Hypertension. Our team of specialists collaborates to offer the most effective treatment plans tailored to each patient’s needs. With a focus on early detection and prompt treatment, we aim to enhance the quality of life for our patients and prevent serious complications such as permanent vision loss.

Why Choose Hannah Joseph Hospital?

Hannah Joseph Hospital combines advanced diagnostic technology with compassionate care to address the unique needs of patients with neurological disorders. Our multidisciplinary approach ensures that each patient receives a personalized treatment plan designed to achieve the best possible outcomes. If you or a loved one is experiencing symptoms of BIH or other neurological conditions, contact Hannah Joseph Hospital today. Our dedicated team is here to support you on your journey to better health.

Author:

Dr. M. J. Arunkumar, M. Ch., DNB
Senior Consultant Neurosurgeon
Hannah Joseph Hospital
Madurai