Benign Intracranial Hypertension treated with Ventriculoperitoneal Shunting

Abstract

A 59-year-old woman complained of headaches and vomiting. On admission, neurological examination revealed bilateral choked disc and tendon hyper-reflexia. Lumbar puncture showed a high opening cerebrospinal fluid (CSF) pressure (195 mmH2O) ; however, protein and sugar levels were normal. The CSF was clear and watery. Computed tomography showed that the bilateral white matter was of low density and the ventricles were compressed bilaterally. Intracranial pressure (ICP), measured continuously by means of a ventricular tube, ranged from 20 to 40 mmHg. The ICP record showed typical A waves and, when an A wave was observed, the patient simultaneously lost consciousness. From these data, the diagnosis of benign intracranial hypertension was established. Intravenous glycerol administration during ICP recording produced only a temporary decrease in ICP. Ventricular external drainage, however, was continuously effective. After a ventriculoperitoneal shunt had been emplaced, the patient recovered. In this case, continuous ICP recording was very useful in both the diagnosis of benign intracranial hypertension and evaluation of its treatment. Shunting is an effective treatment for this disease.