Título

IDIOPATHIC INTRACRANIAL HYPERTENSION: CASE REPORT

Introdução / Purpose

Idiopathic intracranial hypertension (IIH) or pseudotumor cerebri syndrome is a disease characterized by high intracranial pressure, with no sign of expansive intracranial lesion, ventricular enlargement or cerebrospinal fluid (CSF) abnormalities. It predominates in obese women between 20 and 40 years of age. The cause is attributed to an imbalance between the production rate of CSF and its absorption in arachnoid granulations in the sagittal sinus. The predominant symptom is headache, which can be absent in 10% to 30% of cases. The neurological examination is generally normal, except for the presence of papilledema, which may also be absent. Although not life threatening, IIH can cause irreversible damage to the visual field.

Material e Método / Methods

Patient CTA, 21 years old, female, student, complaining of headache and pain at the back of the neck. She has suffered from headaches since childhood. At ophthalmological examination she presented Lumbar puncture with manometry revealed CSF with an increase in proteins (106 mg%) and pressure of 32 cmH2O. Cerebral angiography proved to be normal, in both the arterial and venous phase (Fig. 10-11). .

Resultados / Results

With a worsening in computerized campimetry, it was decided to use a lumbar peritoneal shunt (Fig. 12-14). Symptomatology improved. However, after one month, she experienced painful eye movement, radiating to the occipital region. Later she complained of dizziness and persistent headaches, consistent with low cerebrospinal fluid pressure caused by excess valve drainage. The valve was replaced by another that allowed better CSF control (Fig. 15). Symptoms disappeared, papilledema regressed (Fig. 16-17) and the visual field improved.

Discussão e Conclusões / Discussion

Weight loss associated with acetazolamide therapy has caused more rapid papilledema resolution in patients with IIH. Therapy with corticosteroids and repeated lumbar puncture (weekly or twice a month) can also be used. The ventriculoperitoneal shunt has been substituted by the lumbar peritoneal shunt.

Palavras Chave

INTRACRANIAL, IDIOPATHIC, HYPERTENSION

Area

CLINICAL RETINA