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Título

IDIOPATHIC INTRACRANIAL HYPERTENSION:

Resumo

Idiopathic intracranial hypertension (IIH) or pseudotumor cerebri syndrome is a disease characterized by high intracranial pressure, with no sign of expansive intracranial lesion, ventricular enlargement or cerebrospinal fluid (CSF) abnormalities. It predominates in obese women between 20 and 40 years of age. The diagnosis of IIH is by exclusion, whose criteria include the signs and symptoms of intracranial hypertension, normal imaging examination and normal CSF composition (sometimes with hypoproteinorraquia) and an increase in pressure (above 25 cmH2O). The cause is attributed to an imbalance between the production rate of CSF and its absorption in arachnoid granulations in the sagittal sinus. The predominant symptom is headache, which can be absent in 10% to 30% of cases. Loss of vision starts at the peripheral level, and is barely perceived by the patient. The neurological examination is generally normal, except for the presence of papilledema, which may also be absent. Although not life threatening, IIH can cause irreversible damage to the visual field. Patient CTA, 21 years old, female, student, complaining of headache and pain at the back of the neck. She reported diagnosis of deviated septum and ethmoid sinusitis. She has suffered from headaches since childhood. At ophthalmological examination she presented with bilateral papilledema (Fig. 1-6). A CSF flow study with nuclear magnetic resonance of the brain was normal, with no ventricular dilation (Fig.7). Lumbar puncture with manometry revealed CSF with an increase in proteins (106 mg%) and pressure of 32 cmH2O. Cerebral angiography proved to be normal, in both the arterial and venous phase (Fig. 10-11). The patient was treated with acetazolamide, but with no improvement in clinical picture. With a worsening in computerized campimetry, it was decided to use a lumbar peritoneal shunt (Fig. 12-14). Symptomatology improved. However, after one month, she experienced painful eye movement, radiating to the occipital region. Later she complained of dizziness and persistent headaches, consistent with low cerebrospinal fluid pressure caused by excess valve drainage. The valve was replaced by another that allowed better CSF control(Fig. 15). Symptoms disappeared, papilledema regressed (Fig. 16-17) and the visual field improved, visualized in computerized perimetry.

Referências Bibliográficas

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