Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Headache, worse on straining Visual obscurations or diplopia may occur Examination reveals papilledema Abducens palsy is commonly present +++ General Considerations ++ Thrombosis of the transverse venous sinus as a complication of otitis media or chronic mastoiditis is one cause, and sagittal sinus thrombosis may lead to a clinically similar picture Other causes Chronic pulmonary disease Systemic lupus erythematosus Uremia Endocrine disturbances such as hypoparathyroidism, hypothyroidism, or Addison disease Vitamin A toxicity Use of tetracycline or oral contraceptives Cases have also followed withdrawal of corticosteroids after long-term use Idiopathic intracranial hypertension No specific cause can be found Occurs most commonly among overweight women aged 20–44 Screening for space-occupying lesion of brain is important +++ Clinical Findings +++ Symptoms and Signs ++ Symptoms Headache Diplopia Other visual disturbances due to papilledema and abducens nerve dysfunction Examination reveals Papilledema Some enlargement of the blind spots Patients otherwise look well +++ Differential Diagnosis ++ Venous sinus thrombosis Dural arteriovenous malformation Space-occupying lesion, eg, brain tumor Meningitis Systemic hypertension Migraine Glaucoma Associated conditions Hypoparathyroidism Addison disease Hypothyroidism Chronic pulmonary disease Systemic lupus erythematosus Uremia Associated drugs Vitamin A Tetracycline Minocycline Oral contraceptives Corticosteroid withdrawal Isotretinoin Danazol +++ Diagnosis +++ Laboratory Tests ++ Lumbar puncture confirms intracranial hypertension, but the cerebrospinal fluid is normal +++ Imaging Studies ++ CT or MRI shows small or normal ventricles and an empty sella turcica MR venography is important in screening for thrombosis of the intracranial venous sinuses +++ Treatment +++ Medications ++ Acetazolamide (250–500 mg three times daily orally increasing slowly to a maintenance dose of up to 4000 mg daily, divided two to four times daily) reduces formation of cerebrospinal fluid Topiramate See Table 24–2 Has been shown to be effective Has added benefit of causing weight loss Furosemide (20–40 mg/day) may be helpful as adjunct therapy Corticosteroids (eg, prednisone 60–80 mg/day) are sometimes prescribed but side effects and the risk of relapse on withdrawal have discouraged their use Any specific cause of intracranial hypertension requires appropriate treatment Hormone therapy should be initiated if there is an underlying endocrine disturbance Discontinue the use of tetracycline, oral contraceptives, or vitamin A If corticosteroid withdrawal is responsible, the medication should be reintroduced and then tapered more gradually ++Table Graphic Jump LocationTable 24–2.Medication treatment for seizures in adults (in alphabetical order within classes).View Table|Favorite Table|Download (.pdf) Table 24–2. Medication treatment for seizures in adults (in alphabetical order within classes). Medication Usual Adult Daily Oral Dose Minimum No. of Daily Doses Time to Steady-State Drug Levels Optimal Drug Level and Laboratory Monitoring1 Selected Side Effects ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options