title: Emergency department presentation of idiopathic intracranial hypertension.
abstract: Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a syndrome characterized by an elevated intracranial pressure in the absence of a focal lesion, infective process, or hydrocephalus. New onset IIH may present to the emergency department in a variety of ways. To describe the etiologic associations and clinical features in this disorder, we performed a retrospective analysis of consecutive emergency department patients with new onset IIH during the calendar years 1987-1996. A total of 52 patients met all study criteria. The mean patient age was 27+/-8.9 years; the female-to-male ratio was 7:1. An etiologic association could be identified in 85% of cases and included obesity, hypertension, drugs, endocrine, and systemic disorders. Headache was a dominant complaint in most patients (48/52) and associated with dizziness, nausea, and/or visual complaints. Fourteen patients (27%) were not diagnosed on their initial ED visit and were more likely to have atypical clinical features (71% vs. 24%; P = .004). Atypical features included paraesthesias, neck/back pain, unilateral headache, vertigo, and nystagmus. Papilledema, the ophthalmoscopic hallmark of IIH, was not detected initially in 11 patients (21%). These results suggest that IIH is a relatively uncommon neurological illness that may have a variety of causes. The emergency department diagnosis may be complicated by atypical clinical features and a lack of detectable papilledema.
authors.affiliation: Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, MI, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Jones
authors.forename: J
authors.initials: J
authors.lastname: Nevai
authors.forename: M P
authors.initials: MP
authors.lastname: Freeman
authors.forename: D E
authors.initials: DE
authors.lastname: McNinch
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001766:Blindness / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010211:Papilledema / Q000209:etiology; D011559:Pseudotumor Cerebri / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D017678:Sex Distribution