G93.2
DESCRIPTION
Patients present with symptoms (chronic headache, visual disturbance or loss due to papilloedema and tinnitus) and signs (papilloedema) of raised intracranial pressure without structural intracranial abnormality and with normal CSF composition.
Diagnosis
All patients should have neuro-imaging (CT scan).
- If this is normal, i.e. the absence of structural lesions or hydrocephalus, perform a lumbar puncture and measure intracranial pressure.
- Diagnosis is confirmed by the presence of raised CSF pressure >20 cm H20.
GENERAL MEASURES
Stop medicines associated with benign intracranial hypertension (e.g. doxycycline, corticosteroids, combined oral contraceptives).
Regular monitoring of visual fields is crucial.
Weight loss.
Repeated lumbar punctures with measurement of opening pressure (do lumbar puncture with patient in left lateral position).
Consider surgery if there is progression of visual defects, despite medical therapy, visual loss at onset or severe papilloedema.
MEDICINE TREATMENT
Discuss all cases with a specialist.
For visual involvement, persistent headaches, or severe papilloedema:
- Acetazolamide, oral, 250 mg 12 hourly, maximum dose 2 g daily LoEII [50]
OR
- Furosemide, oral, 40 mg daily.
REFERRAL
- For neuro-imaging, if not available locally.
- Visual symptoms or deterioration of visual fields for opthalmology evaluation.
- Patients not responding to therapy or in need of surgical management.