What are the symptoms of idiopathic intracranial hypertension?

Idiopathic intracranial hypertension (HIH) refers to the pressure in the brain that causes episodes of headaches and vision problems. Idiopathic means the cause is not known, intracranial means in the skull, and hypertension means high pressure.

IIH, also known as Primary intracranial hypertension, and pseudotumor, is a condition caused by the buildup of cerebrospinal fluid (CSF) in the brain. This buildup of fluid causes increased pressure inside the skull. This pressure causes symptoms such as frequent or severe headache episodes and temporary loss of vision. Although the disease is not life threatening, untreated HII can lead to permanent vision loss.

IIH is diagnosed in 7.8 people out of 100,000 each year. This number continues to rise along with the rise in obesity levels.

In this article, we discuss IIH, including its symptoms, risk factors, and effects on daily activities.

IIH is a condition that causes high pressure inside the skull with no known cause. It occurs when CSF, a clear fluid that surrounds and protects the brain and spinal cord, builds up in the skull. This increases the pressure on the brain and optic nerves, which can cause episodes of headaches and changes in vision.

The disease is also known as primary intracranial hypertension, which helps to differentiate it from secondary intracranial hypertension (HSI). IIH occurs without a known cause, while ISH has an identifiable cause, such as a brain tumor, use of certain drugs, or an underlying condition.

People with HIH usually have signs and symptoms of high CSF pressure around the brain. A majority of them suffer from severe persistent disorders headache episodes, sometimes accompanied by nausea or vomiting. Other symptoms may include:

  • vision changes
  • loss of lateral (peripheral) vision
  • blind spots
  • double vision
  • neck and shoulder pain
  • tinnitus (ringing in the ears)

The increased intracranial pressure (ICP) can cause pressure on the optic nerve. This is called papillary edema, and it’s a common finding that can Support the diagnosis of HII. It usually affects both eyes symmetrically, and the threat of vision loss depends on its severity.

Many people may notice or experience visual field loss only at late stages. Once a person with CISD loses their vision, they are unlikely to regain it, even if they manage their PIC.

Another common symptom of HIH is transient visual obscuration, or temporary loss of vision. These are episodes of Blurred vision, followed by recovery of vision. These periods of vision loss can affect one or both eyes.

There is no known cause of HIH, which is why health experts refer to the condition as idiopathic. Doctors theorize that some cases of increased ICP could result from increased production or reduced absorption of CSF.

If doctors are able to identify a cause of ICP, such as a stroke, blood clot, brain tumor, or certain medications, they will diagnose the condition as HIS.

Although IIH can affect anyone, it is almost 20 times more common in women of childbearing age who are more than 20% over the recommended weight for their height, making doctors suspect that hormones play a role in HIH. The disease can also affect men and children, but at a significantly lower frequency.

A doctor will perform several tests to check for signs of IIH. These may involve the contribution of an ophthalmologist and a neurologist, who are doctors who specialize in the eyes and the nervous system, respectively.

Initially, an ophthalmologist will likely perform a dilated eye exam to check eye health and look at the back of the eye. They may also perform a visual field exam to test for peripheral vision.

A neurologist will perform tests to check that the symptoms are not the result of another condition. These trials May include:

  • a physical exam
  • brain imaging tests such as a CT scan or MRI to see the structure of the eyes and ventricles (spaces that contain CSF) in the brain
  • a lumbar puncture to measure CSF pressure and check the ICP

For most people with HIH, symptoms improve with processing. The main goals of treatment are to relieve symptoms, reduce ICP, and preserve vision.

Lifestyle and diet changes

The initial treatment options will usually involve lifestyle and diet changes. These changes may help with weight loss in obese people and may reduce symptoms of HIV or help prevent recurrence after treatment. Doctors can advise people on strategies for achieving or maintaining moderate weight safely.


Doctors can prescribe several medications for HIV. Typically, these drugs will help reduce the buildup of CSF. Certain medications can also help reduce headache episodes. Medicines that a doctor can prescribe understand:

  • acetazolamide
  • methazolamide
  • furosemide
  • topiramate

Lumbar puncture

A lumbar puncture, also known as a lumbar puncture, is a procedure that can help measure CSF pressure. It can also relieve some symptoms. It involves inserting a needle into the spinal canal to collect the CSF. By observing the changes in CSF, the healthcare team will be able to recommend appropriate medications, and even surgery if necessary.


If people do not respond to medications or if lumbar punctures fail, they may require surgery to relieve the pressure. Typically, a doctor can perform one of two types of surgery: optic nerve fenestration or implantation of a neurosurgical shunt.

Fenestration of the optic nerve involves a doctor making a small opening in the sheath surrounding the optic nerve to relieve swelling around the nerve. This procedure can help protect vision, but usually does not reduce headache episodes.

A neurosurgical shunt is a thin tube that a doctor places in the brain or spine to help drain extra CSF from other areas of the body. This surgery can help protect vision and reduce headache episodes, but there is a risk of complications, such as infections and blockages.

In most cases, HIH is treatable and symptoms go away. But some people may experience permanent vision loss. In situations where a person has become blind, they may be eligible for disability benefits under the Americans with Disabilities Act.

A 2015 study have found that visual disturbances, headache episodes, and the risk of sleep apnea can negatively impact a person’s quality of life. Likewise, another 2015 study mentions that headache episodes contribute significantly to poor quality of life in people with HIH.

Medications that a doctor may prescribe for HIH can have side effects such as dizziness, confusion, visual disturbances, and difficulty concentrating. For example, by taking topiramate can make using machines and driving unsafe, so people are advised to avoid these activities while taking these medicines.

Although HIH is considered rare, it is advisable for a person to contact their healthcare professional if they experience episodes of severe and recurring headaches and changes in their vision, such as vision loss. temporary or double vision. People who meet risk factor criteria (for example, being female, aged 20 to 50, or suffering from obesity) should contact their doctor if they have these symptoms.

IIH is a rare neurological disease that causes increased pressure of fluids in the skull and around the brain for an unknown reason. Symptoms usually manifest as episodes of severe headaches and changes in vision. These symptoms can significantly interfere with a person’s daily functioning and quality of life unless the condition is treated.

If a person notices symptoms of HIH, it is advisable to contact a doctor for a diagnosis. Treatment options for reducing pressure in the skull may involve lifestyle changes, medications, a lumbar puncture, and surgery.

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