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Idiopathic intracranial hypertension

Last reviewed: 6 Apr 2025
Last updated: 04 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • visual field loss
Full details

Other diagnostic factors

  • headache
  • transient visual obscurations
  • pulse-synchronous tinnitus
  • photophobia
  • retrobulbar pain
  • optical disk swelling
  • decreased visual acuity
  • ocular motility disturbances
  • relative afferent pupillary defect
Full details

Risk factors

  • female sex
  • obesity and weight gain
  • certain medication use
  • associated causal diseases
  • sleep apnea
  • family history
Full details

Diagnostic tests

1st tests to order

  • visual field testing (perimetry)
  • dilated fundoscopy
  • visual acuity
  • MRI of brain with or without contrast
  • lumbar puncture at spinal L3/L4
Full details

Tests to consider

  • magnetic resonance venogram of head
  • optical coherence tomography
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Michael Wall, MD

Professor

Department of Neurology and Department of Ophthalmology & Visual Sciences

University of Iowa Hospitals & Clinics and Iowa City VA Health Care System

Iowa City

IA

Disclosures

MW is an author of a number of references cited in this topic.

Mansoor Mughal, MD

Retina Fellow

Rutgers University

Robert Wood Johnson University Hospital

New Brunswick

NJ

Disclosures

MM declares that he has no competing interests.

Peer reviewers

Paul W. Brazis, MD

Consultant in Neurology and Neuro-Ophthalmology

Mayo Clinic Florida

Jacksonville

FL

Disclosures

PWB declares that he has no competing interests.

Tim D. Matthews, MBBS

Consultant Neuro-ophthalmologist

Birmingham Neuro-ophthalmology Unit

University Hospital Birmingham

Birmingham

UK

Disclosures

TDM declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Wall M. Idiopathic intracranial hypertension. Neurol Clin. 2010 Aug;28(3):593-617.Full text  Abstract

Johnson LN, Krohel GB, Madsen RW, et al. The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri). Ophthalmology. 1998 Dec;105(12):2313-7. Abstract

Hayreh SS. Pathogenesis of oedema of the optic disc (papilloedema): a preliminary report. Br J Ophthalmol. 1964 Oct;48:522-43.Full text  Abstract

Smith JL. Whence pseudotumor cerebri? J Clin Neuroophthalmol. 1985 Mar;5(1):55-6. Abstract

Frisen L. Swelling of the optic nerve head: a staging scheme. J Neurol Neurosurg Psychiatry. 1982 Jan;45(1):13-8.Full text  Abstract

NORDIC Idiopathic Intracranial Hypertension Study Group Writing Committee; Wall M, McDermott MP, Kieburtz KD, et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA. 2014 Apr 23-30;311(16):1641-51.Full text  Abstract

Hoffmann J, Mollan SP, Paemeleire K, et al. European Headache Federation guideline on idiopathic intracranial hypertension. J Headache Pain. 2018 Oct 8;19(1):93.Full text  Abstract

Sinclair AJ, Burdon MA, Nightingale PG, et al. Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study. BMJ. 2010 Jul 7;341:c2701.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Idiopathic intracranial hypertension images
  • Differentials

    • Intracranial structural anomalies
    More Differentials
  • Guidelines

    • European Headache Federation guideline on idiopathic intracranial hypertension
    More Guidelines
  • Patient information

    Obesity - drugs and surgery

    Obesity - diet and exercise

    More Patient information
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