Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Diagnosing Idiopathic Intracranial Hypertension
Michael Wall, MD
Department of Ophthalmology and Visual Sciences
University of Iowa
Peer Review Status: Internally Peer Reviewed
Creation Date: 1991
Last Revision Date: 2001
The diagnosis of IIH is made by identifying the typical
symptoms of the disease along with documentation of a high
spinal fluid pressure (done during a spinal tap). The
neurologic examination is normal except for the presence of
swollen optic nerves called papilledema (seen by examining
the back of the eye). (Figs 3-8) Sometimes double vision
occurs, caused by limitation of lateral eye movement.
Lastly, neuroimaging procedures such as CT scans or MRI
scanning are normal.
Figure 3. Normal optic nerve (central pinkish disk)
Figure 4. An optic nerve with mild swelling
(papilledema).
Note the pathologic"C"-shaped halo of edema surrounding the
optic disk (Grade I papilledema).
Figure 5. Grade I papilledema, Another example of an
optic nerve with mild papilledema.
Figure 6. Grade II papilledema. The halo of edema now
surrounds the optic disc.
Figure 7. Grade IV papillededema. With more severe
swelling in addition to a circumferential halo, the edema
covers major blood vessels as they leave the optic disk
(grade III) and vessels on the disk (grade IV).
A subretinal hemorrhage is present at 7 o'clock.
Figure 8. Pseudopapilledema. A patient with an elevated
optic nerve present since birth. There is no halo, no major
vessel covering a small nerve with abnormal vessel branching
and tortuosity.
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