Benign intracranial hypertension
- obese females at greatest risk
- given that many obese females become pregnant, pregnancy is an associated, although not necessarily causative risk factor
- most common symptoms are headache and visual disturbances (shadows, dark patches, black spots)
- papilledema is almost universal; if not present, benign intracranial hypertension unlikely; afferent pupillary defect and 6th cranial nerve palsy may be noted
- benign intracranial hypertension is a diagnosis of exclusion
- given that cerebral venous sinus thrombosis can present similarly, must exclude by MRV or CTV; CTV while exposing the fetus to radiation uses contrast (Iohexol) which is less toxic, category B, relative to gadolinium, category C
- while benign intracranial hypertention often has a benign course, up to 10% of patients may become blind and must be treated very aggressively
- treatment modalities: repeat LP's, acetazolamide (category C), shunt, optic nerve fenestration
Source
Menon, R. et al "Headache and Pregnancy" The Neurologist. v 14. March 2008.
Ball, A. et al "Idiopathic intracranial hypertention" Lancet Neurology. v 5. May 2006.