Exam Cram

• Presentation: 

  • Headache with raised ICP (worse in mornings, leaning forward, coughing), 

  • Eyes: loss of peripheral vision, diploplia & papilloedema

  • BMI ++, 20-30F

• Diagnosis: lumbar puncture opening pressure > 30mmhg

• Management

  • 1. Weight loss

    2. Acetazolamide

    3. Therapeutic CSF drainage (lumbar puncture)

Outline

Background 

• 10% of IIH could have Cerebral Vein Thrombosis 

Assessment

History

• Chronic headaches with raised ICP- worse in mornings, coughing/ straining

• Loss of peripheral vision

• Associations: COCP, recent tetracyclines, steroids or retinoids

Examination

• Obesity

• Bitemporal hemianopia

Investigations

• CT-H: may shows signs of raised intracranial pressure

• Lumbar puncture: opening pressure > 25

Diagnosis

Diagnostic criteria: CSF opening pressure > 25mmhg

Differentials: Cerebral Vein Thrombosis, Tension Headache, Migraine 

Management

1. Weight reduction: diet, exercise; consider liraglutide; stop tetracyclines, steroids or retinoids

2. Acetazolamide

3. Therapeutic lumbar punctures

4. Surgical interventions: e.g. CSF shunts

Med Reg Notes

• Prednisolone may be used to acutely improve raised ICP headache and papilloedema in the emergency setting, under specialist approval. 

Written in 2025.