Klinik für Neurochirurgie

What is IIH?

Idiopathic Intracranial Hypertension is a condition caused by increased pressure (=hypertension) in the head (=intracranial).

Idiopathic means that there is no direct trigger for the increased pressure, such as a mass, or sinus vein thrombosis.

Synonym: The obsolete term "pseudotumor cerebri" is no longer in use.

What are the symptoms?

Typically, there are signs of increased intracranial pressure with headaches, more in the area of the forehead and eyes, which increase when lying down. In addition, visual disturbances or visual loss are often noted.

Other, more nonspecific complaints are frequently mentioned - nausea, sensitivity to light, double vision, ringing in the ears/ear pressure, worsening of symptoms with movement, difficulty concentrating. Paradoxical headaches that improve when lying down may also occur during the course of the disease.

IIH patients are disproportionately affected by migraine.

What are the risk factors?

The vast majority of affected individuals are women of childbearing age who are overweight.

The underlying contributing mechanisms are still unclear. Obesity appears to be an important factor. In addition to hydrodynamic causes, evidence points towards metabolic and hormonal interrelationship.

Is there IIH without a papilloedema?

IIH can also exist without papilloedema (IIHWOP - IIH without papilloedema). The diagnosis can be made in case of corresponding findings in diagnostics and in the presence of at least 3 signs in MRI:

•     Empty sella
•     Flattening of the posterior bulb
•     Dilatation and distortion of the optic nerve sheaths
•     Stenosis of the transverse sinus

How to treat IIH?

The basic treatment of IIH always requires an interdisciplinary team.

The main goal: Protect vision. Alleviate symptoms.

The basic building blocks are:

• optimal case management    
• medical treatment
• weight reduction 
• if necessary, to be implemented quickly and efficiently invasive therapies
• headache treatment