idiopathic intracranial hypertension primary intracranial hypertension Bening intracranial hypertension Pseudotumor cerebri meningitis serosa

1. This lecture is lovingly
dedicated to all radiologists,
clinicians with special gratitude
to my family, our staff and to
each of whom has a special
place in my heart.
DEDICATION
Idiopathic intracranial hypertension
NB: Use animations to see radiological images.

2. Taif; Saudi arabia.
1700 to 3000 m above sea level.
Dr: Magdy Mahsoub
Role of CT, MRI and US.
Idiopathic intracranial hypertension

3. Trauma
Hydrocephalus
Dural sinus thrombosis
SOL
Idiopathic intracranial hypertension

4. Quincke (1897) was the first to describe and name
this syndrome "meningitis serosa“ shortly after he
introduced the lumbar puncture into medicine.
Nonne (1904) termed this syndrome "pseudotumor
cerebri" as the symptoms resembled a suspected
intracranial mass.
Foley (1955) renamed the condition
"benign intracranial hypertension".
Corbett et al (1982) altered the name to idiopathic
intracranial hypertension, since the syndrome was
not benign as once thought. In some cases, up to 25%
of patients may lose their vision.
History
Pseudotumor cerebri (PTC)
Benign intracranial hypertension (BIH)
Idiopathic intracranial hypertension (IIH)
Idiopathic intracranial hypertension

5. Modified Dandy criteria
Symptoms of increased ICP.1
No localizing signs except VI CN palsy.2
The patient is awake and alert.3
Normal CT/MRI W/O mass or thrombosis.4
LP CSF pressure >25 cmH2o with normal CSF.5
No other cause for increased ICP6
Dandy criteria
S&S of increased ICP. CSF pressure >25 cmH2o .1
No localizing signs except VI CN palsy.2
Normal CSF composition.3
Normal to small (slit) ventricles on imaging with no mass.4
Idiopathic intracranial hypertension

6. Pressure
Obese female at childbearing age.
The disease may be seen in any age group but has a high
predilection among women in childbearing age. In the
prepubertal age group, IIH has no particular predilection to
obesity or female gender.
Risk factors
Abdomen
Chest
Head
Idiopathic intracranial hypertension

7. Syndrome of IIH at high altitude
In health science high altitude means 1500m to
summit of Everest (8850m)
Generally, different people have different
susceptibilities to altitude sickness. Symptoms can
begin to appear at 1500 meters above sea level.
Hypoxia
Hypercoagul
ability
Cerebral
edema
Idiopathic intracranial hypertension

8. Lyme disease
Bahcet disease
Renal failure
Hypercoagulability
Anemia
Myeloma
Pregnancy
Obesity
SLE
Turner S
Sleep apnea
Respiratory insufficiency
High blood p.
Hyper/Hypo
Idiopathic intracranial hypertension

9. BTSS; Bilateral Transverse Sinus Stenosis.
Brain Priapism /~ IIH
Priapism is pathological elevation of the venous pressure of the
male genitalia due to venous outflow obstruction or compression.
Pathophysiology of IIH may be analogous to that of priapism.
Pathophysiology: Remain unclear.
Idiopathic intracranial hypertension

10. Tinnitus (ringing in the ears).
Sleep and behavior disturbances (insomnia, …)
Headaches
Nausea
Vomiting
Dizziness
Drowsiness
Blurring of vision
Diplopia (6th CN palsy) Visual loss
Vertigo Neck and shoulder pain
Seizure
Idiopathic intracranial hypertension

11. Idiopathic intracranial hypertension

12. Exclude
TraumaInfarction
HydrocephalusDural sinus thrombosis
MeningitisSOL

13. # Papilloedema; Flattening of the posterior sclera /
Protrusions of the ON head: ~ 80%. Restricted DWI.
 ON:
Idiopathic intracranial hypertension
# Enhancement of the prelaminar ON: ~ 50%.
 Partial empty sella: ~ 70%.
 Stenosis of one/both TS: CTV / MRV.
# Vertical tortuosity of the ON: ~ 40%.
# Prominent subarachnoid space around the
ON: ~ 45%. Dilated ONSD.
 Prominent/Giant arachnoid granulation.
Any body understand?
No
 Mega cisterna magna (MCM).

14. IIH
Ultrasound

16. Idiopathic intracranial hypertension
NB

17. Treatment

18. Loss of Wt. for obese patient
Idiopathic intracranial hypertension

19.  Lumbar puncture.
 Medication.
 Venous sinus stenting
 Surgery.
Idiopathic intracranial hypertension

20.  Lumbar puncture.
 Medication.
 Venous sinus stenting
 Surgery.
Acetazolamide … (Diamox)
Idiopathic intracranial hypertension

21.  Lumbar puncture.
 Medication.
 Venous sinus stenting
 Surgery.
Idiopathic intracranial hypertension

22.  Lumbar puncture.
 Medication.
 Venous sinus stenting
 Surgery.
Idiopathic intracranial hypertension

23. LP shut
Neurosurgery
ON fenestration
 Lumbar puncture.
 Medication.
 Venous sinus stenting
 Surgery.
Shunt
Idiopathic intracranial hypertension

24. Magdy Mahsoub
Idiopathic intracranial hypertension