Idiopathic Intracranial Hypertension

WHAT YOU SHOULD KNOW:

• Idiopathic (id-e-o-PATH-ik) intracranial (in-trah-KRA-ne-al) hypertension (hi-per-TEN-shun), or IIH, is a condition where the pressure inside the skull (head) is higher than normal. It happens without any obvious reason. With IIH, the pressure in the brain may become very high and squeeze the nerves in the brain. The nerve of the eye is the most commonly affected which may lead to blurring or loss of vision. IIH usually occurs in women of childbearing age and whose weight is much heavier than what is recommended by their caregiver.
  
  
• Blurring, loss of vision, or a blind spot in the field of vision, and headache are common symptoms of IIH. You may also hear pulsating (heartbeat-like), whooshing, or roaring in the ears. Other symptoms may include joint pain, neck stiffness, and numbing of the skin. IIH can only be diagnosed once other possible causes of intracranial hypertension have been ruled out. Blood tests, imaging tests of the brain, eye tests, and lumbar puncture may help diagnose IIH. Treatment may include watchful waiting, weight loss, medicines, lumbar punctures, and surgery. With treatment, more serious problems of IIH may be prevented, and you may be able to go back to your usual activities.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Some IIH treatments cause side effects. Certain medicines may lead to kidney stone formation or may be very dangerous to take if you are pregnant. You could bleed too much with surgery or get an infection. Sometimes, surgery may also fail and you may need to repeat this surgery in the future. If untreated, IIH may cause more serious problems. It may cause very bad headaches and may lead to blindness. IIH may cause depression, affect self-esteem, and limit your activity. The success of treating IIH is best when it is diagnosed and treated as soon as possible. Ask your caregiver if you are worried or have questions about your condition, care, or treatment.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Medicines: Your caregiver may give you the following kinds of medicines:

• Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
  
  
• Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.
  
  
• Others: Medicine to decrease production or amount of cerebrospinal fluid (CSF) inside your skull may be given. CSF is a clear fluid that is around the brain and spine. It is normally produced by the ventricles (spaces inside the brain) and then absorbed by blood vessels into the blood system.

Tests: Caregivers may do different eye tests to check if the high pressure in your brain is affecting your eyes. They will also check how well you see things around you. You may also have any of the following tests:

• Angiography: This test uses a dye that is put in your eye and then a special camera will take pictures of the inside of your eye. The dye helps the blood vessels show up better in these pictures.
  
  
• Indirect ophthalmoscopy: This test uses a magnifying lens to see your retina and other parts of your eye. Eyedrops are placed into your eyes to dilate (widen) the pupils. The pupil is the dark circle in the middle of the eye.
  
  
• Slit-lamp test: This test uses a microscope with a strong light to look into your eyes.
  
  
• Stereoscopic fundus photography: You may have this test to check your eye for swelling or to see if an eye problem is getting worse.
  
  
• Visual acuity test: Your caregiver may ask you to read special eye charts. These charts help your caregiver check how well you see colors, lines, and at different distances.
  
  
• Lumbar puncture: This is a procedure where a needle is inserted in your back and into the spinal canal. During a lumbar puncture, CSF pressure will be measured. CSF may be collected and sent to a lab for tests. The tests check for changes in the CSF, including the presence of blood, protein, sugar, and germs.
  
  
• Magnetic resonance imaging: Using magnetic waves, this test, also called an MRI, takes pictures of your head. During the MRI, you may also have a test called magnetic resonance venography. You may be given a dye before the test is done. Magnetic resonance imaging and venography help caregivers see if a problem in your brain or its blood vessels is causing your condition.

Treatment options: Treatment may depend on how long you have had the IIH. You may need any of the following:

• Lumbar puncture: Lumbar punctures may be done to decrease the spinal fluid pressure and ease your headache.
  
  
• Surgery: Surgery may be needed if treatment with medicines fails and your vision is at risk.
  
  
  • Optic nerve sheath decompression: Caregivers make a small opening or window in the sheath (cover) around the optic nerve. This opening allows fluid to drain and relieves pressure in the eye.
    
    
  • Shunting: Caregivers insert a catheter (tube) which connects to another area of the body. This serves as a passageway to drain the CSF.
    
    
  • Other surgery: Surgery to help lose weight may be needed if you are extremely overweight. This is done when medicines and surgery do not seem to treat the condition.

Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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