Benign (Idiopathic) Intracranial Hypertension

Benign (Idiopathic) Intracranial Hypertension (BIH) sometimes termed “pseudotumour cerebri”, is a poorly understood condition in which the intracranial pressure is elevated without any mass or increase in CSF volume.

Patients are most frequently female, often carrying significant extra weight and usually aged 20-40 (although no age is immune).

Patients present with headache, which may be associated with nausea or vomiting, or with diplopia (double vision) or other visual disturbance.

Dandy Criteria for Benign (Idiopathic) Intracranial Hypertension

  1. Signs and symptoms of elevated intracranial pressure – measured ICP greater than 25 cm H2O
  2. No localising neurology (with the exception of abducens nerve palsy)
  3. Normal CSF composition
  4. Small (slit) ventricles with no mass lesion on imaging

CSF pressure is usually initially measured by lumbar puncture, and repeated lumbar puncture may be employed as a treatment strategy.

Other treatments include medication to reduce CSF production (Diamox), and weight loss is strongly recommended, and may assist.

Certain medications may be associated with this condition (tetracycline antibiotics, hormonal contraceptives (isotretinoin for acne), and should be reviewed if present

If medical treatment is unsuccessful surgery may be considered, particularily if visual symptoms and signs are present (including swelling of the optic nerve head (papilloedema).

Surgical options to consider are optic nerve fenestration, or shunting (lumboperitoneal or ventriculoperitoneal).