Senthilnathan, J (2014) Analysis of Clinical Profile, Laboratory Investigations and Management Modalities of Patients with Idiopathic Intracranial Hypertension. Masters thesis, Madras Medical College, Chennai.
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Abstract
Idiopathic Intracranial Hypertension (IIH) is defined as a clinical syndrome characterized by elevated intracranial pressure, in the absence of an identifiable pathology (hydrocephalus or space occupying lesion). It is characterized by the presence symptoms of raised intracranial pressure viz. head ache, vomiting, blurring of vision, pulsatile tinnitus, double vision, transient visual obscurations and signs of raised intracranial pressure (ICP) , like papilledema, VI th cranial nerve palsy, and investigations revealing increased cerebrospinal fluid (CSF) pressure with normal biochemical and cytologic analysis of CSF. This disease has been referred by various names since Quincke first described it as “meningitis serosa” as early as 1893. Various terminologies used includes ‘otitic hydrocephalus” ‘Pseudotumour cerebri‘, ‘benign intracranial hypertension’. The term ‘ Benign intracranial hypertension’ which was in use for very long time, since Foley introduced it in 1955, was reconsidered as several reports of visual loss in these patients questioned the benign nature of this illness and hence it was renamed as ‘Idiopathic Intracranial Hypertension’. IIH is considered as a disease of altered CSF flow dynamics resulting in increased CSF pressure. It is considered in those patients where a detailed neuro-imaging ruled out any structural cause for raised intracranial pressure. Incidence of disease is high among obese, young female patients. This study tries to analyse the various clinical presentation, investigations of IIH, with the outcome of illness. We also analyse the clinical presentation, investigations of IIH that can predict early surgical intervention in these patients. AIM OF THE STUDY : To study the clinical profile of the patients with Idiopathic Intracranial Hypertension To study the co–relation between clinical presentation, CSF analysis, management and outcome of patients with Idiopathic Intracranial Hypertension CONCLUSION : In our study we analysed the demographic features, clinical presentation, investigations and outcome of IIH patients, following conclusions were observed Majority of our patients were in 2nd – 3rd decade. There was high female preponderance in our study. Obesity was the most common risk factor. Headache is the universal presenting symptom in all patients, followed by diplopia and visual disturbances. All of them had papilledema as a predominant finding, followed by lateral rectus palsy but no other focal neurologic deficits. Typical imaging findings of IIH were present in majority of patients. Three fourths of our patients had elevated CSF opening pressure. Significant number of patients with normal opening pressure had raised CSF Rout and classical symptoms and imaging findings of IIH which helped in diagnosis. One fourth of the patient improved with medications alone and remained symptom free by three months . Three fourths of the patients had recurrence of symptoms, which was managed with increased dosage of drugs and half of them showed improvement in symptoms. Eighteen percent of the patients underwent surgery for recurrence of symptoms while remaining were managed conservatively. Among the parameters assessed, high BMI in the range of obesity, decreased visual acuity early in course of illness and presence of peri optic nerve sheath widening in MRI were more associated with need for surgical intervention .
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Analysis of Clinical Profile ; Laboratory Investigations ; Management Modalities of Patients ; Idiopathic Intracranial Hypertension. |
| Subjects: | MEDICAL > Neurology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 30 Jun 2017 02:42 |
| Last Modified: | 30 Jun 2017 05:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/673 |
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