Benign intracranial

November 12, 2012

Benign intracranial

Many patients presenting with raised intracranial pressure will find that there is, apparently, no known cause for their condition. Even it is essential to receive prompt treatment of even benign intracranial pressure in order to avoid permanent damage to sight.

Whilst there is no known cause for benign intracranial pressure there are some known risk factors, including -

  • Obesity

  • Menstrual irregularity

  • Women are more at risk than men

  • Recent weight gain, fluid retention and cases in the first part of pregnancy and post-pregnancy have all been noted as possible factors.

As well as some known risk factors there are also some known associations -

  • Hypo- and hyperthyroidism

  • Certain medications

  • Adrenal insufficiency

  • Iron deficiency and anaemia

  • Chronic renal failure

  • Systemic lupus erythematosus

As may well be expected headaches tend to be the first symptom of benign intracranial pressure which may appear to be a generalised headache worsening in the morning and evening. This mild headache may have been occurring for a lengthy period of time. Patients may report that the headache is much better when they are standing – this is a recognised indicator of the presence of benign intracranial pressure. Coughing or straining may irritate the headache.

It may also be noticed by the patient that they are experiencing a gradual worsening of their vision – some greying out, or short flashes of lights or a halo effect. There may also be some persistent blurring.

As the benign intracranial pressure worsens the patient may become drowsy and complain of nausea – followed usually by vomiting.

Since all of these symptoms may also be caused by something other than benign intracranial pressure some investigation by a medical practitioner maybe necessary in order to exclude any other possible causes.

  • CT or MRI

  • Visual charting – investigation of any blind spot and the peripheral field

  • Lumbar puncture

Immediately after diagnosis a patient will be clearly advised to lose weight since obesity is a high level risk factor for benign intracranial pressure. Diuretic medication may also be supplied as a prerequisite for other treatment under consideration and to help reduce the intracranial pressure. The aim of treatment will be relief of symptoms and prevention of further deterioration in the optic nerve. If it is suspected that there is an underlying condition then this must be treated immediately – if there are any suspect medications in the patients existing regime then they must be stopped. It may be necessary to undergo a series of lumbar punctures in order to control the intracranial pressure. Oral steroids such as prednisone may be prescribed for headache relief.

In the event of the failure of non-invasive treatments then surgery will need to be considered – with optic nerve decompression and lumboperitoneal shunting both being an option.

Whilst most patients do respond well to treatment it has been noted that the recurral rate is fairly high – around 30% of patients will have a relapse. As many as 50% of patients may suffer some permanent vision loss and around 10% will be left with significant disability.

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