Can Idiopathic Intracranial Hypertension (IIH) cause intermittent dizziness?

Idiopathic Intracranial Hypertension and Dizziness

Yes, Idiopathic Intracranial Hypertension (IIH) can cause intermittent dizziness as one of its recognized symptoms. 1, 2 Dizziness is specifically listed among the constellation of symptoms that can occur in patients with IIH, alongside more commonly recognized manifestations such as headache, visual disturbances, and pulsatile tinnitus.

Symptom Profile of IIH

IIH presents with a range of neurological symptoms that result from increased intracranial pressure:

Common Symptoms

• Headache (progressive, often worse in morning or when lying flat)
• Papilledema
• Visual disturbances (transient visual obscurations, blurred vision)
• Pulsatile tinnitus

Less Frequently Discussed Symptoms

• Dizziness
• Neck pain
• Back pain
• Cognitive disturbances
• Radicular pain
• Horizontal diplopia 1, 2

Pathophysiological Basis for Dizziness in IIH

While the exact mechanism causing dizziness in IIH isn't fully elucidated in the guidelines, it likely relates to:

1. Direct effects of increased intracranial pressure on vestibular pathways
2. Pressure effects on cranial nerves involved in balance
3. Altered cerebral perfusion due to elevated intracranial pressure

Clinical Implications

When evaluating a patient with intermittent dizziness who may have IIH, clinicians should:

• Look for concurrent symptoms typical of IIH, particularly headache, visual changes, and pulsatile tinnitus
• Pay special attention to risk factors for IIH, especially female gender, reproductive age, and BMI >30 kg/m² 2
• Remember that dizziness alone is not sufficient for diagnosis but should prompt consideration of IIH in the appropriate clinical context

Diagnostic Approach

If IIH is suspected in a patient with dizziness:

1. Confirm papilledema through fundoscopic examination
2. Obtain neuroimaging (urgent MRI brain within 24 hours)
3. Perform lumbar puncture to measure opening pressure and analyze CSF composition
4. Look for characteristic MRI findings such as empty sella, flattening of posterior globes, and distention of perioptic subarachnoid space 2

Clinical Pitfalls to Avoid

• Misdiagnosis is common - IIH is both underdiagnosed and misdiagnosed 2
• Dizziness may be attributed to more common conditions without consideration of IIH
• Delayed recognition of increased ICP can result in irreversible neurological damage and permanent vision loss 2
• Atypical presentations (patients who aren't female, of childbearing age, or obese) may be overlooked

Management Considerations

For patients with IIH presenting with dizziness:

• Address the underlying increased intracranial pressure through weight loss and acetazolamide 3
• Monitor for improvement in all symptoms, including dizziness, as intracranial pressure normalizes
• Consider surgical interventions (optic nerve sheath fenestration, CSF shunting) if medical therapy fails 3

Remember that while headache and visual symptoms often receive the most attention in IIH management, addressing the elevated intracranial pressure should also improve associated symptoms like dizziness.