Abstract
The pseudotumor cerebri syndrome embraces disorders characterised by raised intracranial pressure, where the commonest symptom is headache (90%). Idiopathic intracranial hypertension without papilloedema (IIHWOP) is increasingly recognised as a source of refractory headache symptoms and resultant neurological disability. Although the majority of patients with IIHWOP are phenotypically similar to those with idiopathic intracranial hypertension (IIH), it remains uncertain as to whether IIHWOP is nosologically distinct from IIH. The incidence, prevalence, and the degree of association with the world-wide obesity epidemic is unknown. Establishing a diagnosis of IIHWOP can be challenging, as often lumbar puncture is not routinely part of the work-up for refractory headaches. There are published diagnostic criteria for IIHWOP; however, some report uncertainty regarding a pathologically acceptable cut off for a raised lumbar puncture opening pressure, which is a key criterion. The literature provides little information to help guide clinicians in managing patients with IIHWOP. Further research is therefore needed to better understand the mechanisms that drive the development of chronic daily headaches and a relationship to intracranial pressure; and indeed, whether such patients would benefit from therapies to lower intracranial pressure. The aim of this narrative review was to perform a detailed search of the scientific literature and provide a summary of historic and current opinion regarding IIHWOP.
Highlights
The neurological disability of headache ranks second to only to stroke [1]
It could be postulated that chronic daily headache (CDH), which occurs in approximately 4% of the population and 6.8% of individuals with morbid obesity could be undiagnosed intracranial hypertension (IIH) without papilloedema (IIHWOP)
We have summarised the literature on headache in the presence of elevated cerebrospinal fluid (CSF) opening pressure, in the absence of papilloedema, to include the initial description, epidemiology, proposed aetiology, common clinical features, diagnosis, and potential future management options
Summary
The neurological disability of headache ranks second to only to stroke [1]. The pseudotumor cerebri syndrome (PTCS) embraces disorders characterised by raised intracranial pressure (ICP) [2], where the commonest symptom is headache (90%) [3]. The most prevalent of these disorders is idiopathic intracranial hypertension (IIH), which is typically found in women of child-bearing age, who are obese and where papilloedema may be sight-threatening [4,5,6]. It could be postulated that chronic daily headache (CDH), which occurs in approximately 4% of the population and 6.8% of individuals with morbid obesity could be undiagnosed IIHWOP. There are currently no recommended treatment options for IIHWOP. In this narrative review, we have summarised the literature on headache in the presence of elevated cerebrospinal fluid (CSF) opening pressure, in the absence of papilloedema, to include the initial description, epidemiology, proposed aetiology, common clinical features, diagnosis, and potential future management options
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