• headache (94%)
• transient visual obscurations or blurring (68%)
• pulse synchronous tinnitus or "wooshing noise" in the ear (58%)
• pain behind the eye (44%)
• double vision (38%)
• visual loss (30%)
• pain with eye movement (22%)

Headache Headache is present in nearly all patients with IIH and is the usual symptom for which patients seek medical attention. The headaches of the IIH patient are usually severe and daily; they are are often throbbing. They are different from previous headaches, may awaken the patient and usually last hours. Nausea is common and vomiting less so. The headache is often the worst head pain ever experienced. Although uncommon, the presence of pain behind the eyeball that is worsened movements of the eyes can occur.

Transient visual obscurations Visual obscurations are episodes of transient blurred vision that usually last less than 30 seconds and are followed by full recovery of vision. Visual obscurations occur in about 3/4 of IIH patients. The attacks may be involve one or both eyes. They are not correlated with the degree of intracranial hypertension or with the extent of optic nerve swelling. Visual obscurations do not appear to be associated with poor visual outcome.

Pulsatile intracranial noises Pulsatile intracranial noises or pulse-synchronous tinnitus is common in IIH. The sound is often unilateral. In patients with intracranial hypertension, compression of the jugular vein on the side of sound abolishes it. The periodic compressions were thought to convert the laminar blood flow to turbulent.

Visual loss The most serious problem patients have is vision loss. (Figure 9, 10) About 5% of patients go blind in at least one eye. These are usually patients who do not return for follow-up evaluation.

Figure 9. At typical visual field defect present using Goldmann perimetry in an IIH patient. Notice the large blind spot (black filled area) and the lower left indentation (an inferior nasal nerve fiber bundle defect).

Figure 10. A similar inferior nasal nerve fiber bundle defect in an IIH patient found with automated perimeter
(Humphrey perimeter). These defects may resolve fully with treatment.

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