Idiopathic Intra Cranial Hypertension (IIH) is a disorder of unknown aetiology that predominantly affects obese women of childbearing age. The primary problem is chronically elevated Intra-Cranial Pressure (ICP), and the most important neurologic manifestation is papilledema (swelling in optic nerve head) which may lead to secondary progressive optic atrophy, visual loss, and possible blindness. Although IIH, pseudotumor cerebri, and benign Intra-Cranial Hypertension (BIH) are synonymous terms in medical literature, IIH is the preferred term.
A sixteen-year-old girl was presented to the neurologist with complaints of headache and progressive loss of vision over the last three weeks. After thorough clinical and fundus examination coupled with imaging studies, she was diagnosed to have Idiopathic Intra-Cranial Hypertension.
Lumbar puncture revealed elevated csf pressure (35 cm. of csf). She had taken a trial of Acetazolamide (a drug used for reducing csf production thereby leading to decrease in intra cranial pressure) with no improvement. A surgical intervention was needed at the earliest.
After discussion between neurologist, ophthalmologist and neurosurgeon she was planned for bilateral optic nerve sheath fenestration through medial trans conjunctival approach (to avoid upper lid scar).
After surgery, her vision gradually improved from finger counting at one foot to 6/24 bilaterally.
This case qualified for reporting, as this kind of surgery and its approach is very rarely done and needs a close collaboration between neurologist, neurosurgeon and ophthalmologist.
Dr. Ratan Kumar
Sr. Consultant Opthalmology