Intracranial Hypertension

What is Idiopathic Intracranial Hypertension?

Idiopathic intracranial hypertension (IIH) is a condition characterized by significantly elevated pressure inside the skull (intracranial pressure) without structural abnormalities that could cause this increase.

The first reported cases of this condition date back to 1893, just two years after the introduction of lumbar puncture. Despite years of study, its exact causes remain unclear in many cases.

Idiopathic intracranial hypertension is sometimes referred to as benign intracranial hypertension or pseudotumor cerebri. However, calling it "benign" is misleading because some patients experience irreversible vision loss, and pseudotumor cerebri is a term more appropriately used for cerebral venous thrombosis.

Symptoms of Idiopathic Intracranial Hypertension

The most common symptoms include:

• Persistent headaches
• Nausea and vomiting
• Various degrees of vision impairment, sometimes leading to complete blindness

IIH is the second most common condition that presents with both severe headaches and vision disturbances.

Additional symptoms may include:

• Eye movement disturbances
• Double vision in one or both eyes (due to weakness of the sixth cranial nerve)
• Pulsating noises in the ears

While headaches, nausea, and vomiting can be linked to many different conditions, vision loss in IIH typically results from optic nerve swelling (papilledema) or optic nerve atrophy due to prolonged high intracranial pressure.

Causes of Idiopathic Intracranial Hypertension

A typical patient with this condition is a young woman with severe obesity. Women are 8–9 times more likely to develop IIH than men, and over 90% of patients are obese.

Other contributing factors include:

• Hormonal imbalances
• Vitamin A metabolism disorders
• Underactive thyroid gland (hypothyroidism)
• Hormonal contraceptive use
• Cerebral venous stenosis (narrowing of brain veins)

In some cases, the underlying cause remains unknown. IIH can also affect children, men, and individuals with normal body weight.

How Is Idiopathic Intracranial Hypertension Diagnosed?

Imaging Studies:

Patients presenting with these symptoms must undergo MRI scans to assess the brain, optic nerves, and brain veins (venography).

Since IIH often involves subtle changes, the radiologist's experience in interpreting brain imaging is critical. In many cases, MRI results appear normal or show only minor, age-appropriate findings.

Ophthalmologic Evaluation:

Next, the patient must see an ophthalmologist for:

• Fundus examination (to assess the optic nerve head)
• Visual field testing
• Optical coherence tomography (OCT) of the eyes

Lumbar Puncture:

If MRI findings and symptoms suggest IIH, a lumbar puncture is required to:

• Measure cerebrospinal fluid (CSF) pressure
• Analyze CSF samples

What Should You Do If Diagnosed with IIH?

If you or a loved one has confirmed or suspected IIH, a neurosurgical consultation is necessary.

We offer in-person and remote consultations via video calls. Appointments can be scheduled online, via phone, or email. Contact us to arrange a remote consultation.

Treatment Options for Idiopathic Intracranial Hypertension

Since IIH causes headaches and vision disturbances, medical attention should not be delayed. Treatment must be initiated and monitored by a neurosurgeon.

Initial treatment depends on:

• Possible underlying causes (e.g., obesity, medication use, cerebral venous narrowing)
• Severity of symptoms (especially vision impairment)

Conservative (Non-Surgical) Treatment:

For patients with mild symptoms, treatment may include:

• Aggressive weight loss (for obese individuals)
• Medications that reduce cerebrospinal fluid (CSF) production

Surgical Treatment:

Surgery is necessary for patients with rapid disease progression or worsening vision loss.

• If the primary issue is vision impairment (with minimal or no headaches), optic nerve sheath fenestration may be performed to relieve pressure on the optic nerve.
• If symptoms include severe headaches and vision problems, shunt surgery may be required to divert excess cerebrospinal fluid (CSF) into the abdominal cavity.

There are two types of shunt procedures:

1. Ventriculoperitoneal shunting – redirects CSF from brain ventricles into the abdomen.
2. Lumboperitoneal shunting – redirects CSF from the spinal canal (lumbar region) into the abdomen.

Both surgeries rapidly and effectively reduce intracranial pressure. The choice of procedure depends on the neurosurgeon's evaluation and will be explained during consultation.

Our surgical facility, where procedures and interventions take place, is the modern, well-equipped Aiwa Clinic.

If you are considering surgery with us, you can read patient testimonials from both Latvian and international patients.