Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre

Authors

  • Niraj Gautam Tribhuvan University Institute of Medicine, Kathmandu, Nepal
  • Rajeev Ojha Tribhuvan University Institute of Medicine, Kathmandu, Nepal https://orcid.org/0000-0001-7680-7036
  • Sanjeev Kharel Tribhuvan University Institute of Medicine, Kathmandu, Nepal
  • Bikram Prasad Gajurel Tribhuvan University Institute of Medicine, Kathmandu, Nepal
  • Sanjeeta Sitaula Tribhuvan University Institute of Medicine, Kathmandu, Nepal
  • Ragesh Karn Tribhuvan University Institute of Medicine, Kathmandu, Nepal
  • Reema Rajbhandari Tribhuvan University Institute of Medicine, Kathmandu, Nepal
  • Ashish Shrestha Tribhuvan University Institute of Medicine, Kathmandu, Nepal

DOI:

https://doi.org/10.3126/nmj.v4i2.40038

Keywords:

Acetazolamide, Chronic headache, Idiopathic intracranial hypertension, Visual loss

Abstract

Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center.

Materials and Methods: We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up.

Results: Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain.  Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H20 and > 30 cm H20 in 37.5%. 15 Idiopathic Intracranial Hypertension patients (93.7%) were subtyped as Typical and 1 patient was diagnosed as Fulminant Idiopathic Intracranial Hypertension. Acetazolamide was used for treatment in 15 patients and 1 patient needed ventriculoperitoneal shunting. 56% Seven patients (44%) had some abnormal findings: partial empty sella (44%), and tortuous optic nerve (31%), flattened posterior eyeball (31%), and hypoplastic transverse sinus (19%).

Conclusions: Idiopathic Intracranial Hypertension is an uncommon diagnosis but should be suspected in patients with chronic headaches with visual impairment. In low-resource settings, proper history along with neurological and ophthalmological examinations can even detect the early features and timely referral can save the vision and disability of Idiopathic Intracranial Hypertension patients.

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Author Biographies

Niraj Gautam, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Department of Neurology

Rajeev Ojha, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Department of Neurology, Asst. Professor

Sanjeev Kharel, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Maharajgunj Medical Campus

Bikram Prasad Gajurel, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Department of Neurology

Sanjeeta Sitaula, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Department of Ophthalmology

Ragesh Karn, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Department of Neurology

Reema Rajbhandari, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Department of Neurology

Ashish Shrestha, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

Departmentof Neurology

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Published

2021-12-31

How to Cite

Gautam, N., Ojha, R., Kharel, S., Gajurel, B. P., Sitaula, S., Karn, R., Rajbhandari, R., & Shrestha, A. . (2021). Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre. Nepalese Medical Journal, 4(2), 468–472. https://doi.org/10.3126/nmj.v4i2.40038

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Original Articles