IDIOPATHIC INTRACRANIAL HYPERTENSION (IIH) (Pseudotumor Cerebri)

Causes:

            Increased intracranial pressure (ICP) usually due to:

            Weight gain in a young female

            Excessive vitamin A intake: liver, kale/greens, carrots, multi-vitamins, cod liver oil

            High salt diet: processed meats, soup, most snacks, sports drinks (ex. Gatorade), most bread

            Obstructive sleep apnea (OSA)

            Blocked vein in the brain, MRI/MRV will rule this out

            Medications: for acne (tetracycline, doxycycline, minocycline, retina A pills), lithium, steroids, etc

Symptoms:

            Headaches, especially when laying down, bending over, coughing, staining or lifting

            Blurred vision, often temporarily worse when bending over, coughing or lifting for several seconds

            Double vision (diplopia), side-by-side double vision at distance

            Neck stiffness

            Pulsating noise in the ears (hearing your heartbeat in your head)

Evaluation:

            MRI/MRV brain with contrast to rule out mass, hydrocephalus, blocked cerebral vein, etc.

            Lumbar puncture (LP) in some cases to measure the opening pressure (normal usually <25 cm) and                to lower the ICP temporarily, and to send spinal fluid for analysis (rarely abnormal)

            Sleep study and CPAP machine if OSA suspected

Treatment:

            At least 6% weight loss (Low Carb diet/Intermittent Fasting diet/big lunch+small dinner/increased                  exercise)

            Low salt and vitamin A diet (<5g salt=<1 teaspoon/day, no processed meats/fast food/most                              breads/snacks/soy sauce/soup/most Asian and Mexican food), and low vitamin A diet (no liver,                      avoid kale/greens/carrots/spinach/sweet potatoes/multivitamins

            Stop acne pills (acne creams usually ok), and lower or stop lithium or steroids if possible

            Treat obstructive sleep apnea with a CPAP machine and weight loss

            Medication: Diamox (acetazolamide), Topamax (topiramate), or a diuretic (HCTZ, spironolactone,                      furosemide)

            Surgery: Optic nerve sheath fenestration or a shunt in brain or spine if needed to rapidly lower the                  ICP in severe cases                                                                                                                                      01/17/23