The patient is a 37 y/o female who presents with complaints of two months of intermittent severe frontal headaches associated with some decreased vision, nausea/vomiting and photophobia.





Diagnosis: idiopathic intracranial hypertension (pseudotumor cerebri)

This young female patient presents with a history typical for IIH: intermittent severe headaches with transient visual obscurations and visual loss.  Another historical feature to ask about is pulse synchronous tinnitus (pulsatile tinnitus), which is present even more commonly than vision loss and is much more specific for the disease. This patient’s opening pressure was found to be 42, closing pressure 20 with marked improvement of symptoms.1

Optic nerve sonography can be used to identify intracranial hypertension through the measurement of the optic nerve sheath diameter (ONSD), since an increased intracranial pressure (ICP) of different etiologies results in enlargement of the ONSD.2,3,4

Take home points:


1. Wall M. Idiopathic intracranial hypertension. Neurol Clin. 2010;28(3):593-617. [PDF]

2. Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10(4):376-81. [PDF]

3. Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care. 2009;11(3):406-10. [pubmed]

4. Geeraerts T, Merceron S, Benhamou D, et al. Noninvasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 2008;12(Suppl 2):117. [pubmed]

5. Dawson, Mallin. Introduction to Bedside Ultrasound, Volume 2. 2013. Apple iBook. [iBook]

6. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011;37(7):1059-68. [pubmed]

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