What are the symptoms of pseudotumor cerebri (idiopathic intracranial hypertension)?

Symptoms of Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

The most common symptoms of pseudotumor cerebri include headache (present in nearly 90% of patients), visual disturbances including papilledema, transient visual obscurations, pulsatile tinnitus, and diplopia due to sixth nerve palsy. 1, 2

Primary Symptoms

• Headache - The most frequent symptom, typically diffuse and progressively more severe over days to weeks 1

  • May sometimes present as thunderclap headache or migrainous type 1
  • Can occur as isolated symptom without focal neurological findings in up to 25% of cases 1

• Visual Disturbances 1, 2

  • Papilledema (swelling of the optic disc) - A characteristic finding
  • Transient visual obscurations (unilateral or bilateral darkening of vision typically lasting seconds) 1
  • Visual blurring 1
  • Decreased visual acuity 3
  • Constricted visual fields 3

• Pulsatile tinnitus (whooshing sound in the ears) 1, 2

• Diplopia (double vision) - Typically horizontal, often due to sixth nerve palsy 1, 3

Secondary Symptoms

• Dizziness 1
• Neck pain 1
• Back pain 1
• Cognitive disturbances 1
• Radicular pain 1

Less Common Manifestations

• Facial weakness - Seen in some complicated cases 3
• Arm weakness - Reported in rare cases 3
• Diffuse ophthalmoparesis (weakness of eye movements in multiple directions) - Uncommon 3
• Scalp edema and dilated scalp veins - May be observed on examination in cases involving superior sagittal sinus 1

Clinical Patterns Based on Venous Involvement

• Superior sagittal sinus involvement - May lead to headache, increased intracranial pressure, papilledema, and sometimes motor deficits with seizures 1
• Lateral sinus thromboses - May present with pain in the ear or mastoid region along with headache 1
• Deep cerebral venous system thrombosis (occurs in approximately 16% of CVT cases) - Can lead to thalamic or basal ganglial infarction with rapid neurological deterioration 1

Important Clinical Distinctions

• Pseudotumor cerebri predominantly affects overweight females of childbearing age but can also occur in obese males and prepubertal thin children 1, 2
• The incidence is rising in parallel with the obesity epidemic 1, 2
• Seizures are frequent, occurring in approximately 40% of patients 1
• Bilateral brain involvement is not uncommon, particularly with deep venous drainage system involvement 1
• Isolated headache without focal neurological findings or papilledema occurs in up to 25% of patients and presents a significant diagnostic challenge 1

Warning Signs of Vision Loss

• Progressive vision loss is the most concerning complication and requires urgent treatment 4
• Severe bilateral optic disc edema indicates significant risk to vision 3
• Markedly constricted visual fields in both eyes suggest advanced disease 3

Early recognition of these symptoms is crucial as permanent visual impairment can occur if the condition is not promptly diagnosed and treated 5, 4.