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Essentials of Diagnosis
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Headache, worse on straining
Visual obscurations or diplopia may occur
Examination reveals papilledema
Abducens palsy is commonly present
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General Considerations
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Idiopathic intracranial hypertension
No specific cause can be found in many cases
Occurs most commonly among overweight women aged 20–44
Screening for space-occupying lesion of brain is important
Thrombosis of the transverse venous sinus as a complication of otitis media or chronic mastoiditis is one cause of intracranial hypertension, and sagittal sinus thrombosis may lead to a clinically similar picture
Other causes of intracranial hypertension
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
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Differential Diagnosis
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Venous sinus thrombosis
Dural arteriovenous malformation
Space-occupying lesion, eg, brain tumor
Associated conditions
Associated drugs
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Acetazolamide (250–500 mg orally three times daily, increasing slowly to a maintenance dose of up to 4000 mg daily, divided two to four times daily) reduces formation of cerebrospinal fluid
Topiramate
Furosemide (20–40 mg daily) may be helpful as adjunctive therapy
Corticosteroids (eg, prednisone 60–80 mg daily) are sometimes prescribed but side effects and the risk of relapse on their discontinuation 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
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