Idiopathic Intracranial Hypertension - Idiopathic Intracranial Hypertension - MSD Manual Consumer Version (2024)

Idiopathic intracranial hypertension is characterized by increased pressure within the skull (intracranial pressure). What triggers the disorder is unknown.

  • People have daily or near daily headaches, sometimes with nausea, blurred or double vision, and noises within the head (tinnitus).

  • Imaging of the head is done to rule out possible causes of increased pressure, and a spinal tap is done.

  • Without prompt treatment, vision can be lost.

  • Weight loss, diuretics to reduce fluids in the brain, and spinal taps done periodically to reduce the pressure can help, but surgery is sometimes needed.

(See also Overview of Headache.)

Idiopathic intracranial hypertension occurs in only about 1 of 100,000 people, usually in women during their reproductive years. However, among young overweight women, it is 20 times more common. As more and more people are becoming overweight, the disorder is becoming more common.

Causes of Idiopathic Intracranial Hypertension

What causes pressure within the skull to increase is unknown. However, certain people are more susceptible to idiopathic intracranial hypertension because the large veins (venous sinuses) that help drain blood from their brain are smaller than in most people. In these people, blood drains from the brain more slowly, causing a back-up of blood, which increases pressure in the brain and/or within the skull.

Exactly how being overweight contributes to increased pressure within the skull is unknown. But excess fat in the abdomen may increase pressure in the chest, and blood may not flow from the head to the chest as it normally does. Thus, pressure within the skull may increase.

In idiopathic intracranial hypertension, the increased pressure does not result from other identifiable disorders, such as tumors, infections, blood clots, or blockages that prevent the fluid that surrounds the brain (cerebrospinal fluid) from draining as it normally does.

In most people, the development of idiopathic intracranial hypertension cannot be traced to any particular event. In children, this disorder sometimes develops after corticosteroids are stopped or after growth hormone is used. Sometimes the disorder develops after people take

Symptoms of Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension usually begins with a daily or almost daily headache, which affects both sides of the head. At first, the headache may be mild, but it varies in intensity and may become severe. The headache may be accompanied by nausea, double or blurred vision, and noises within the head that occur with each beat of the pulse (called pulsatile tinnitus). A few people do not have any symptoms.

Increased pressure within the skull may cause the optic nerve to swell near the eyeball—a condition called papilledema. Doctors can observe the swelling by looking at the back of the eye through an ophthalmoscope.

The first sign of vision problems is loss of peripheral (side) vision. People may not notice this loss at first. As a result, people may bump into objects for no apparent reason. Vision may be blurred briefly, sometimes triggered by changing position, and blurring may come and go. Late in the disorder, vision is blurred, and people may quickly become blind. As many as one third of people lose their vision, partially or completely, in one or both eyes. Once vision is lost, it usually does not return, even if the pressure around the brain is relieved.

In some people, the disorder becomes chronic and progressively worse, increasing the risk of blindness. Doctors closely monitor and treat such people to prevent loss of vision.

Idiopathic intracranial hypertension recurs in about 10 to 20% of people.

Diagnosis of Idiopathic Intracranial Hypertension

  • A doctor's evaluation

  • Imaging tests

  • A spinal tap

Doctors suspect idiopathic intracranial hypertension based on symptoms and results of a physical examination. Sometimes doctors suspect it when they detect papilledema during a routine examination with an ophthalmoscope.

If doctors suspect idiopathic intracranial hypertension, they check the field of vision (the entire area of vision that is seen out of each eye), including peripheral vision. They also examine the interior of the eye with an ophthalmoscope if they have not already done so.

Magnetic resonance venography is done to evaluate the large veins (called venous sinuses) that carry blood from the brain. This test enables doctors to determine whether the venous sinuses are narrowed or blocked. Narrowed venous sinuses may be the only abnormality that imaging tests detect in people with idiopathic intracranial hypertension. Magnetic resonance imaging (MRI) of the brain is also done to check for other abnormalities that could increase pressure within the skull.

A spinal tap (lumbar puncture) is done to measure the pressure of cerebrospinal fluid and to analyze the fluid. In idiopathic intracranial hypertension, the pressure of the fluid is increased, often to very high levels. The content of the fluid is usually normal. As soon as spinal fluid is removed during the spinal tap, the pressure inside the head decreases, the venous sinuses may widen, and more blood may flow from the brain. As a result, the headache lessens.

These and other tests can help identify or rule out other possible causes of increased pressure within the skull (such as a brain tumor blocking the venous sinuses).

Treatment of Idiopathic Intracranial Hypertension

  • Pain relievers or a medication used to prevent or treat migraines

  • If needed, weight loss

  • Sometimes surgery to reduce pressure within the skull

Idiopathic intracranial hypertension occasionally resolves without treatment.

Treatment of idiopathic intracranial hypertension focuses on the following:

  • Relieving symptoms

  • Reducing pressure within the skull

  • Preserving vision

Some Medications Used to Treat Migraines

Reduction of pressure within the skull

Overweight people with idiopathic intracranial hypertension should lose weight because doing so may reduce pressure within the skull. Idiopathic intracranial hypertension may resolve when as little as 10% of body weight is lost. However, weight reduction programs are often unsuccessful.

The usefulness of doing spinal taps daily or weekly to remove cerebrospinal fluid is debated. This treatment may be used when people are at risk of losing their vision while they are waiting for more effective treatment (such as surgery to relieve the pressure within the skull). If regular spinal taps are done, people are closely monitored to determine whether pressure is decreasing. CT venography or magnetic resonance venography may be done again to determine whether the spinal taps widened the venous sinuses. If these veins have widened, more blood can flow out of the brain, and pressure within the skull is reduced.

If people with idiopathic intracranial hypertension have been unable to lose weight, bariatric surgery may help. If people maintain the weight loss after surgery, idiopathic intracranial hypertension may be cured.

Preserving vision

Permanent loss of vision is the main concern in people with idiopathic intracranial hypertension. Because peripheral vision is lost early, before people notice it, an ophthalmologist periodically checks vision, including peripheral vision, using an automated device (a test called perimetry). The device produces a visual stimulus (such as a flash of light) and records the person's responses. Results are very accurate. This periodic testing enables doctors to identify problems with vision as soon as possible.

If vision deteriorates despite these measures, surgery to reduce pressure within the skull may be needed and may be able to save vision. Procedures include

  • Optic nerve sheath fenestration

  • A shunt

  • Stenting

In optic nerve sheath fenestration, slits are cut in the covering of the optic nerve behind the eyeball. These slits allow cerebrospinal fluid to escape into the tissues around the eye, where the fluid is absorbed.

A shunt is a permanent drain made of plastic tubing. It can be surgically placed so that excess cerebrospinal fluid can be removed. The shunt is placed in the spaces within the brain or in the space just below the spinal cord in the lower back. The tubing is run under the skin, usually to the abdomen, where excess fluid can drain.

Stenting involves placing a wire mesh tube (stent) in the narrowed venous sinus. The stent is then opened up to widen the venous sinus.

Weight-loss surgery

If people with idiopathic intracranial hypertension are obese and other measures are ineffective, surgery to help with weight reduction (bariatric surgery, such as a gastric bypass) may be done. If successful, it may cure the disorder.

Idiopathic Intracranial Hypertension - Idiopathic Intracranial Hypertension - MSD Manual Consumer Version (2024)

FAQs

What is the life expectancy of someone with IIH? ›

IIH does not normally affect life expectancy. The major complications from IIH arise from untreated or treatment-resistant papilledema. In various case series, the long-term risk of one's vision being significantly affected by IIH is reported to lie anywhere between 10 and 25%.

What is the difference between idiopathic intracranial hypertension and intracranial hypertension? ›

Intracranial hypertension is increased pressure in your skull. It occurs because of CSF buildup. If you have idiopathic intracranial hypertension, it means healthcare providers don't know what's causing the fluid buildup. Intracranial hypertension can put pressure on your optic nerve.

Does IIH damage the brain? ›

Several small cohort studies have formally assessed memory and cognition in IIH. Studies have shown deficits in key areas such as memory, learning, visuospatial skills, concentration, language and executive function. A retrospective review of 10 cases found impairment in long-term memory, delayed recall and retention.

Is IIH a disability? ›

Can You Receive Disability for Intracranial Hypertension? Yes, there is disability benefits available for people with Intracranial hypertension.

Is coffee good for intracranial hypertension? ›

The acute effects of caffeine on ICP may be a beneficial treatment for patients with acutely elevated ICP such as traumatic brain injury, ischemic stroke, and hemorrhagic stroke, and acutely for idiopathic intracranial hypertension.

Does drinking water help IIH? ›

Staying hydrated.

Water is essential to the body, especially the brain. Dehydration is the number one cause of a headache, yet is reversible by ingesting an adequate amount of water each day3.

Does IIH cause weight gain? ›

Moreover, IIH has been demonstrated to have a distinct pathophysiology that hinders weight loss and promotes further weight gain.

Can IIH cause death? ›

Although IIH itself is not fatal, the elevated risk of death from suicide and accidental overdose among individuals with IIH is a characteristic often observed with chronic disorders that possess fatal outcomes such as multiple sclerosis, amyotrophic lateral sclerosis, and cancer.

Is IIH a lifelong illness? ›

Complications of idiopathic intracranial hypertension

Idiopathic IH is not usually life threatening, but it can be a lifelong problem. It can affect your vision, and there's a risk that you could lose your vision. This is because the increased pressure around the brain can cause swelling of the optic nerve.

Is IIH considered a rare disease? ›

IIH is considered a rare disease. Recent medical reports show that IIH is happening more often.

What percentage of people with IIH go blind? ›

As much as 15 percent of individuals with IIH may be at risk of severe, permanent vision loss.

References

Top Articles
Latest Posts
Recommended Articles
Article information

Author: Merrill Bechtelar CPA

Last Updated:

Views: 5565

Rating: 5 / 5 (50 voted)

Reviews: 89% of readers found this page helpful

Author information

Name: Merrill Bechtelar CPA

Birthday: 1996-05-19

Address: Apt. 114 873 White Lodge, Libbyfurt, CA 93006

Phone: +5983010455207

Job: Legacy Representative

Hobby: Blacksmithing, Urban exploration, Sudoku, Slacklining, Creative writing, Community, Letterboxing

Introduction: My name is Merrill Bechtelar CPA, I am a clean, agreeable, glorious, magnificent, witty, enchanting, comfortable person who loves writing and wants to share my knowledge and understanding with you.