• Idiopathic Intracranial Hypertension (IIH), previously known as Pseudotumor Cerebri, should be considered as a possible etiology of recurrent, often daily, headaches, particularly in obese, female patients.

 

• The pain is typically throbbing, sometimes unilateral, and severe.  In addition to headache, these patients often present with transient visual abnormality (72%), pulsatile tinnitus (60%), photopsia (seeing lights, flashes, colors) (54%), retrobulbar pain (44%), diplopia (38%), and sustained visual abnormality (26%).

 

• The most commonly encountered physical examination findings are (1) papilledema - the greater, the higher the risk for vision loss, (2) visual field loss (always check!), and (3) sixth cranial nerve palsy - due to increased pressure on this long-coursing intracranial nerve.

References

• http://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-clinical-features-and-diagnosis?source=search_result&selectedTitle=1%7E105
• Wall M, George D. Idiopathic Intracranial Hypertension.  A Prospective Study of 50 Patients. Brain. 1991; 114 (Pt 1A):  155.
• Wall M, White WN. Asymmetric Papilledema in Idiopathic Intracranial Hypertension:  Prospective Intraocular Comparison of Sensory Visual Function.  Invest Ophthalmol Vis Sci. 1998; 39(1): 134.