Snapshot An obese 31-year-old female presents to the neurologists office complaining of severe headaches, visual obscurations, ringing in the ears and what her primary care doctor called "papilledema". She has been taking large amounts of vitamin A because a friend told her that it would give her more energy. Examination of the patient shows limited abduction of both eyes. Introduction Idiopathic intracranial hypertension characterized by headache, increased ICP, and papilledema usually not explained by any other identifiable cause Epidemiology incidence 1 per 100,000 demographics more common in younger women median age is approximately 30 years old risk factors child-bearing aged women obesity medications excessive vitamin A or D intake growth hormone OCPs discontinuation of steroids Associated conditions cushings steroid use pregnancy Prognosis does not seem to alter life expectancy Presentation Symptoms pulsatile tinnitus 6th nerve (abducens) palsies severe headaches visual disturbances Physical exam inspection papilledema on fundoscopic exam Evaluation Imaging studies show normal or "slit" ventricles Diagnosis spinal tap elevated CSF pressure (usually > 50 cm) normal CSF profile PE papilledema abducens nerve palsies imaging slit-like ventricles otherwise normal brain MRI Treatment Conservative weight loss Pharmacologic acetazolamide outcomes reduce CSF production side effects abdominal pain kidney stones hypokalemia extremity paresthesias muscle weakness lasix (furosemide) indications when acetazolamide isn't working well enough outcomes reduce fluids by increasing urine output Operative spinal taps or shunts outcomes symptoms can immediately improve by reducing CSF pressure optic nerve sheath fenestration outcomes cut a window into the membrane surrounding the optic nerve allows excess CSF to evacuate visual stabilization Untreated pseudotumor cerebri may lead to development of complete blindness