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Idiopathic Intracranial Hypertension (IIH)

Overview

Idiopathic intracranial hypertension (IIH), also referred to as benign intracranial hypertension or pseudotumor cerebri, is typically seen in middle-aged obese females. It is a condition where the pressure of the fluid around the brain (cerebrospinal fluid – CSF) is abnormally high without any obvious cause, such as a brain tumour.

Patients may experience:

  • Early morning headache that worsens on lying down
  • Blurring of vision
  • Double vision
  • Ringing of ears
  • Nausea and vomiting
  • Occasional confusion, disorientation

The condition occurs due to raised cerebrospinal fluid (CSF) pressure, but the exact cause is often unknown. It may be linked to:

  • Hormonal therapies
  • Polycystic ovary syndrome (PCOS)
  • Excessive vitamin A intake
  • Certain medications (like tetracycline antibiotics)

Doctors may recommend:

  • CSF manometry to check CSF pressure. A value above 18 cm of water is suggestive of IIH
  • Fundus (eye) examination: may show papilloedema (swelling of the optic nerve)
  • MRI of the brain: may show flattening of the optic nerve head, empty sella, or tortuosity of optic nerve

Treatment aims to lower brain fluid pressure and protect vision:

  • Medications: to reduce CSF formation and pressure
  • Lumbar puncture (CSF drainage) to relieve pressure
  • Surgical options in severe cases:
    • Ventriculoperitoneal shunt (tube to drain CSF) if medicines do not work
    • Stenting of venous sinuses if venous sinus thrombosis is the cause of increased CSF pressure
    • Optic nerve fenestration (tiny slit around the optic nerve) to prevent vision loss

Seek immediate care if you have:

  • Severe headache with vision loss or double vision
  • Persistent ringing in the ears with pressure-like headache
  • Sudden worsening of symptoms despite treatment

  • Maintain a healthy weight – gradual weight loss reduces risk and improves symptoms
  • Avoid excessive vitamin A intake and unnecessary hormonal therapy
  • Use medications only as prescribed and discuss side effects with your doctor

For diagnosis and management of IIH, consult a Neurologist (specialist in brain and nerve disorders).

Disclaimer:

The information in this Health Library is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any questions about a medical condition or before starting any treatment. Use of this site and its content does not establish a doctor–patient relationship. In case of a medical emergency, call your local emergency number or visit the nearest emergency facility immediately.