engleski

Idiopathic (benign) intracranial hypertension – is it really a benign condition?

INTRODUCTION: Idiopathic (benign) intracranial hypertension (IIH) or pseudotumor cerebri is disorder characterized by increased intracranial pressure, without any obvious underlying cause. Most common symptoms are headache and vomiting, most prominent sign is n. abducens palsy, while fundoscopy reveals papilledema. Treatment is usually conservative, but in serious cases surgical intervention is required, mostly in form of shunting. METHODS: We present a patient in whom IIH occurred after upper respiratory tract infection with mastoiditis that led to compression of cavernous sinus. Despite polyvalent medicamentous treatment and repeated lumbar punctures, patient had to undergo lumbo- peritoneal (LP) shunting which led to complete remission of symptoms. Two years later control MRI showed development of pseudo-Chiary, protrusion of cerebellar tonsils for 25 mm, which was interpreted as sign of shunt hyperfunction. Patient underwent decompression of posterior fossa, which gave short relief, but soon after uncal herniation appeared, while LP shunt was no longer visible. At that moment patient was in life threatening condition, with high intracranial pressure, severe papilledema and retinal bleeding. Finally, ventriculoperitoneal (VP) shunting was performed, but after initial regression of symptoms, headaches and nausea reoccurred. MRI of LS region showed pseudomeningocele at place of former LP shunt. Since last procedure of LS dural plastic, patient is without any symptom for three years now. CONCLUSIONS: Headache is very common symptom, but also can be a sign of life threatening condition of increased intracranial pressure. Targeted neuroradiological examination is important in diagnostic of IIH, and if disorder does not resolve on conservative treatment, surgical intervention is mandatory, despite all possible complications.

idiopathic intracranial hypertension

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