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What causes idiopathic intracranial hypertension?

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Posted on Thu, 14 Jan 2016
Question: 1- Do I have brain cancer/tumor?

2- Do I have Idiopathic Intracranial Hypertension? and what causes it?
doctor
Answered by Dr. Erion Spaho (1 hour later)
Brief Answer:
There is no brain tumor.

Detailed Answer:
Hello and thanks for using HCM.

I have read your questions and understand your concerns.

Symptoms you describe could be caused by several neurological disorders, not only by a brain tumor.

Regarding to MRI findings that you reported, there is no evidence of any brain tumor, so, you don't have any brain tumor.

There is evidence of increased intracranial pressure ( hydrocephalus ), but no cause is shown.

Regarding your symptoms and MRI findings, there is increased intracranial hypertension and , in my opinion, further evaluation and treatment needed.

Idiopathic intracranial hypertension is a condition that can be found in women at their thirties and obese, without any other neurological diseases.

Fundoscopic examination and lumbar puncture are next steps in evaluating this condition.

If improvement after removal of 30-40 cc. cerebrospinal fluid, then shunting of cerebrospinal fluid should be considered.

Hope you found the answer helpful.

Let me know if I can assist you further.

Take care.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Erion Spaho (14 hours later)
Hello Dr.-

More so than the headache, it's the feeling of lightheadedness that troubles me the most and my on-going sensitive to loud noises and bright lights, and pain behind of my eyes.

Many thanks for responding so quickly! Here are some quick responses to your questions above:

1. No fever? No fever.

2. No nausea or vomiting? I have felt nauseous during this period.

3. Is there neck tightness/pain? No.

4. Are these headaches nearly constant? No they come and go at different times in the day.

5. Are you more sensitive to noise than lights? Yes I am more sensitive to noise and lights of recent.

6. In the past few weeks, along w these headaches do you feel dizzy, lightheaded?? Yes, this is my biggest problem. I nearly collapsed a few days ago, because I felt lightheaded. I think this is one of my primary problems along with PAIN behind the EYES.

We did an endocrine profile to test pituitary function, here are the results:

PM Cortisol: 2.48 (2.3 - 11.9)
AM Cortisol: 6.51 (6.2 - 19.4)
Testosterone: 4.03 (2.8 - 8)
Prolactin: 6.02 (4.6 - 21.4)
T3: 2.98 (2 - 4.4)
TSH: 1.44 (.27 - 4.2)
T4: 1.50 ( 1.04 - 1.65)

Antinuclear Antibodies: Negative
RA Factor: Negative

ESR: 10 (0-9)
WBC: 7.76 (4-10)
Platelets: 338
Haemoglobin: 15.8

I have also attached a few other MRI pics.

Additional questions:

1- Have you reviewed the actual MRI's and not the report? What are you thoughts?

2- DO you suspect IIH? if so, why?

3- Do you see any lesions or cause for concerns?

4- Do you actually see a tortuous optic nerve? If so, what are are causes?

I wanted you to provide an independent view, and not necessarily base your response on the MRI report.

Do you have an email address, so that I can share a google file of the images with you?
doctor
Answered by Dr. Erion Spaho (5 hours later)
Brief Answer:
Follow up.

Detailed Answer:
Hello again and thanks for being in follow up with me.

I have examined MRI pictures you uploaded, they are a few in order to come to a conclusion.

Pituitary tests are within normal ranges, so, it is not the cause of your symptoms.

In order to examine better the MRI, you can upload the DICOM folder/files to google drive and post the link to that folder here.

Awaiting for MRI images.....
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Erion Spaho (3 hours later)
https://drive.google.com/file/d/0B0hTLnojqoLbakZ6OVg4OXhlVVU/view?usp=sharing
doctor
Answered by Dr. Erion Spaho (1 hour later)
Brief Answer:
Follow up.

Detailed Answer:
Hello again XXXXXXX

I examined the MRI images you uploaded carefully.

In my view there is no brain lesion, or tumor, there is empty sella, minimal signs of increased intracranial pressure around the ventricular system, slit-like ventricles and a tortuous left optic nerve.

There is no lesion or mass effect that may justify obstruction of cerebrospinal fluid (CSF) pathways, so, increased intracranial pressure may be related to decreased absorption of CSF, or increased production.

In your case, increased intracranial pressure should be confirmed by funduscopic examination.

Hope this addresses your query sufficiently.

I remain at your disposal for further clarifications.

Regards,
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Erion Spaho (13 hours later)
Thanks Dr., I have a few last follow-up questions:

1-Would these finding all be incidental? Are these issues congenital? Would I have been living with this for a while? I had a bathroom fall 3 months ago, and hit my head pretty hard on the bathroom floor, could this a symptom of that? I am sorry for asking some many questions, however, I am shocked that there are abnormal findings and that Dr's. don't know the cause.

2- Is there anything life threatening? Should I have these tests done quickly?

3- Also, I have noticed that my brain feels foggy. I don't remember things like I used to and I don't feel like my brain is clear or as sharp as it used to be. I am a bit forgetful of recent, could this be symptom if IIH?

4- I am also feeling a bit dizzy, could this have anything to do with the IIH that I am experiencing?

5- What will the fundoscopy tell me?

6- How evasive is the CSF fluid removal? Would you recommend this procedure? How long will it take? Will I be able to return to normal activities quickly?












doctor
Answered by Dr. Erion Spaho (13 hours later)
Brief Answer:
Follow up.

Detailed Answer:
Welcome back XXXXXXX

Symptoms you describe could be caused also by decreased intracranial pressure, besides increased one, so, there is need to get the funduscopic examination done.

These findings could be related to previous head injury if there was blood into subarachnoidal space ( small amounts ) at that time.

Increased intracranial pressure is a condition that if not treated could be fatal.

Before to say that these are incidental findings or not, full work up is needed about achieving the diagnosis.
Funduscopic examination assesses the intracranial pressure by evaluating the edema ( papilledema ) of the optic disc ( nerve ).

If no increase in pressure is found after funduscopic examination, CSF removal is not necessarily, so, I don't recommend it in the first place.

CSF removal is an invasive procedure that uses a needle insertion through your skin and muscles into your spinal cord.

If there are complications, the return to normal activities is quick ( days after ).

In conclusion, get the further tests done.




Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Erion Spaho (31 hours later)
Hello Dr.-

Did you notice any small FLAIR hyperintensities in the midbrain and around posterior horns of lateral ventricles?
doctor
Answered by Dr. Erion Spaho (2 hours later)
Brief Answer:
Follow up.

Detailed Answer:
Welcome back XXXXXXX

I reviewed the MRI images and didn't found any abnormal signal with clinical importance in the brainstem.

FLAIR hyperintensities around ventricles, as I mentioned before, are common findings in conditions such increased intracranial pressure.

Hope this helps.

Greetings.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Erion Spaho (2 hours later)
In your opinion, is this anything that is of concern? Or should I just ignore and carry on?

Thanks Dr. it was helpful.

I am curious to know, however, if we are missing anything here. As I reported, I had a fall 3 months ago, could my symptoms be related to that? (i.e. concussion ?). Could a mild concussion be the cause? or Meningitis?

Best-
doctor
Answered by Dr. Erion Spaho (35 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Welcome back.

Concussion symptoms don't last that long, meningitis is an emergency situation that doesn't pass unnoticed.

In addition, there are no such data on MRI to support concussion or meningitis.

In this moment, best thing to do is to wait and see the progression of your condition, with a follow up MRI in about three months.

Best regards.
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3917 Questions

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What causes idiopathic intracranial hypertension?

Brief Answer: There is no brain tumor. Detailed Answer: Hello and thanks for using HCM. I have read your questions and understand your concerns. Symptoms you describe could be caused by several neurological disorders, not only by a brain tumor. Regarding to MRI findings that you reported, there is no evidence of any brain tumor, so, you don't have any brain tumor. There is evidence of increased intracranial pressure ( hydrocephalus ), but no cause is shown. Regarding your symptoms and MRI findings, there is increased intracranial hypertension and , in my opinion, further evaluation and treatment needed. Idiopathic intracranial hypertension is a condition that can be found in women at their thirties and obese, without any other neurological diseases. Fundoscopic examination and lumbar puncture are next steps in evaluating this condition. If improvement after removal of 30-40 cc. cerebrospinal fluid, then shunting of cerebrospinal fluid should be considered. Hope you found the answer helpful. Let me know if I can assist you further. Take care.