Differential Diagnosis for Headache with High Opening Lumbar Pressure
- Single Most Likely Diagnosis
- Idiopathic Intracranial Hypertension (IIH): This condition is characterized by elevated intracranial pressure without a detectable cause, often presenting with headache and, upon lumbar puncture, high opening pressure. It is more common in obese women of childbearing age.
- Other Likely Diagnoses
- Space-Occupying Lesions (e.g., tumors, abscesses): These can cause increased intracranial pressure, leading to headache and elevated lumbar puncture opening pressure due to the mass effect.
- Cerebral Venous Sinus Thrombosis: This condition can lead to increased intracranial pressure and headache. The thrombosis can cause obstruction of cerebrospinal fluid (CSF) absorption, resulting in elevated opening pressure on lumbar puncture.
- Meningitis: Inflammation of the meninges can cause increased intracranial pressure and headache. While the primary concern is infection, the inflammatory response can lead to elevated CSF pressure.
- Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although typically presenting with a "thunderclap" headache, it's crucial to consider this diagnosis due to its high morbidity and mortality. Elevated lumbar puncture opening pressure can be seen, and blood in the CSF can confirm the diagnosis.
- Central Nervous System (CNS) Infection (e.g., encephalitis, abscess): These conditions require prompt diagnosis and treatment to prevent serious complications or death. High intracranial pressure and headache can be presenting symptoms.
- Rare Diagnoses
- Pseudotumor Cerebri due to Other Causes (e.g., vitamin A toxicity, tetracycline use): These are less common causes of increased intracranial pressure without a mass lesion, which can present similarly to IIH.
- Dural Venous Fistula: An abnormal connection between a vein and an artery in the dura mater can lead to increased venous pressure, causing symptoms similar to those of other conditions with elevated intracranial pressure.
- Cranial Vault Lesions (e.g., osteopterosis): Rare conditions affecting the bones of the skull can lead to increased intracranial pressure due to altered bone structure or function.