Approach

Idiopathic intracranial hypertension (IIH) is a syndrome characterised by increased intracranial pressure and its associated signs and symptoms in an alert and orientated patient but without localising neurological findings.[31] There is no evidence of deformity or obstruction of the ventricular system, and neurodiagnostic studies are otherwise normal except for increased cerebrospinal fluid (CSF) pressure. Furthermore, no secondary cause of intracranial hypertension is apparent. The disease can either be self-limited or have a lifelong chronic course.[31]

Clinical features about which patients should be asked include headaches, neck and shoulder pain, pulse-synchronous tinnitus, transient visual obscurations, photophobia, visual loss, and diplopia.

Signs that may be found on examination include optic disc swelling, sixth nerve paresis, and disturbances in sensory visual function. Visual field loss is ubiquitous, and the prototype pattern for early loss is enlargement of the blind spot and inferonasal loss.[32] The modified Dandy criteria can be used as diagnostic criteria.[33][34]com.bmj.content.model.Caption@5dc7f859[Figure caption and citation for the preceding image starts]: Bilateral disc oedemaFrom the personal collection of Dr M. Wall; used with permission [Citation ends].com.bmj.content.model.Caption@622841c9[Figure caption and citation for the preceding image starts]: Bilateral disc swelling settledFrom the personal collection of Dr M. Wall; used with permission [Citation ends].com.bmj.content.model.Caption@593e2f45[Figure caption and citation for the preceding image starts]: Bilateral optic atrophyFrom the personal collection of Dr M. Wall; used with permission [Citation ends].

BMJ Best Practice is an evidence-based point of care tool for healthcare practitioners.

To continue reading and access all of BMJ Best Practice's pages you'll need to log in or start a free trial.

You can access through your institution if your hospital, university, trust or other institution provides access to BMJ Best Practice through either OpenAthens or Shibboleth.

Use of this content is subject to our disclaimer