Location
Suwanee, GA
Start Date
7-5-2024 1:00 PM
End Date
7-5-2024 4:00 PM
Description
Idiopathic Intracranial Hypertension (IIH) is a condition in which intracranial pressures become elevated with no clear or obvious cause. While the pathophysiology remains elusive, a multitude of medications, comorbid states, and risk factors have been attributed to IIH. Clinical presentation includes intense headaches with papilledema, tinnitus, and transient vision loss. IIH is a diagnosis of exclusion and patients are often instructed to lose weight and provided medication in the event of flare ups.
Case 1
Patient GA was a 23 year old Caucasian female at the time of diagnosis with a BMI of 34.3 kg/m2. Personal history at the time of diagnosis was significant for migraines, tension headaches, periodic edema, and sleep apnea. She reports a negative history of vitamin A excess, recent antibiotics, or growth hormone excess. She admitted to prior use of combined oral contraceptive birth control but none containing levonorgestrel. Now as a postmenopausal patient, she reports continuing to have episodes attributed to IIH. After her initial presentation from 1995-1997, she had subsequent episodes 2004-2007, 2011-2014 and 2018, lasting until present day, each treated with acetazolamide. Initial presentation included an intense pain at the top of her head without additional neurologic deficits. After an emergency room visit and additional appointments, she was diagnosed with IIH. Recurrent episodes of IIH have left her with bilateral blindspots.
Case 2
Patient SV was a 24 year old Caucasian female at the time of diagnosis with a BMI 47.5 kg/m2. Medical history at the time of diagnosis was significant for IBS, anxiety, depression, intussusception and menstrual headaches. She denies vitamin A excess, recent antibiotics, or growth hormone excess. At the time of diagnosis, she relayed she was likely using a combined oral contraceptive. She described her presentation at diagnosis as an aching pain behind her eyes accompanied by feelings of vertigo. A lumbar puncture during her subsequent hospitalization demonstrated an opening pressure of 33 and after ruling out other causes, she was diagnosed with IIH. She was given Acetazolamide and Topiramate for one year and discontinued both when her symptoms resolved. The episode lasted from 2014-2017 and she has not had any complications.
Discussion
In documenting these cases, we hope to contribute to the greater understanding of disease and aid in elucidating a better understanding of the risk factors involved in the development of IIH. It is important for the medical community to be more aware of IIH due to its potential to cause severe, progressive neurologic complications. Increased awareness increases considerations of IIH when making differential diagnosis in patients with headaches and visual disturbances, as early diagnosis and intervention are crucial to reducing complications, such as irreversible vision loss. Advanced awareness contributes to ongoing research efforts about underlying pathophysiologic mechanisms and optimal treatment options. A greater collective knowledge will improve patient outcomes and the quality of care within the healthcare community.
Embargo Period
6-25-2024
Included in
A case comparison of two instances of Idiopathic Intracranial Hypertension
Suwanee, GA
Idiopathic Intracranial Hypertension (IIH) is a condition in which intracranial pressures become elevated with no clear or obvious cause. While the pathophysiology remains elusive, a multitude of medications, comorbid states, and risk factors have been attributed to IIH. Clinical presentation includes intense headaches with papilledema, tinnitus, and transient vision loss. IIH is a diagnosis of exclusion and patients are often instructed to lose weight and provided medication in the event of flare ups.
Case 1
Patient GA was a 23 year old Caucasian female at the time of diagnosis with a BMI of 34.3 kg/m2. Personal history at the time of diagnosis was significant for migraines, tension headaches, periodic edema, and sleep apnea. She reports a negative history of vitamin A excess, recent antibiotics, or growth hormone excess. She admitted to prior use of combined oral contraceptive birth control but none containing levonorgestrel. Now as a postmenopausal patient, she reports continuing to have episodes attributed to IIH. After her initial presentation from 1995-1997, she had subsequent episodes 2004-2007, 2011-2014 and 2018, lasting until present day, each treated with acetazolamide. Initial presentation included an intense pain at the top of her head without additional neurologic deficits. After an emergency room visit and additional appointments, she was diagnosed with IIH. Recurrent episodes of IIH have left her with bilateral blindspots.
Case 2
Patient SV was a 24 year old Caucasian female at the time of diagnosis with a BMI 47.5 kg/m2. Medical history at the time of diagnosis was significant for IBS, anxiety, depression, intussusception and menstrual headaches. She denies vitamin A excess, recent antibiotics, or growth hormone excess. At the time of diagnosis, she relayed she was likely using a combined oral contraceptive. She described her presentation at diagnosis as an aching pain behind her eyes accompanied by feelings of vertigo. A lumbar puncture during her subsequent hospitalization demonstrated an opening pressure of 33 and after ruling out other causes, she was diagnosed with IIH. She was given Acetazolamide and Topiramate for one year and discontinued both when her symptoms resolved. The episode lasted from 2014-2017 and she has not had any complications.
Discussion
In documenting these cases, we hope to contribute to the greater understanding of disease and aid in elucidating a better understanding of the risk factors involved in the development of IIH. It is important for the medical community to be more aware of IIH due to its potential to cause severe, progressive neurologic complications. Increased awareness increases considerations of IIH when making differential diagnosis in patients with headaches and visual disturbances, as early diagnosis and intervention are crucial to reducing complications, such as irreversible vision loss. Advanced awareness contributes to ongoing research efforts about underlying pathophysiologic mechanisms and optimal treatment options. A greater collective knowledge will improve patient outcomes and the quality of care within the healthcare community.