Ophthalmological symptoms of idiopathic intracranial hypertension: Importance for diagnosis and clinical course

Abstract

Ophthalmological symptoms, particularly papilledema and transient visual obscuration as well as pulsatile head and ear noises are hallmarks of idiopathic intracranial hypertension also known as pseudotumor cerebri. Pronounced asymmetrical and unilateral papilledema are common occurrences in patients with idiopathic intracranial hypertension. Distension of the optic nerve sheath indicates increased intracranial pressure, which need to be confirmed by lumbar puncture. The presence of papilledema indicates increased intracranial pressure but its absence does not exceed it. Previous and long-standing papilledema obviously induces changes of the optic disc which prevent the further development of major disc swelling. The development of visual atrophy can mimic a regression of papilledema. In cases of marked papilledema visual loss may be caused by nonarteritic, ischemic optic neuropathy or macular edema. Visual obscuration is present in the vast majority of cases of pronounced chronic papilledema and is an indication of long-standing increased intracranial pressure. Most patients with pseudotumor cerebri and papilledema show only mild visual field defects, such as an enlarged blind spot and/or relatively mild arcuate defects, which regress after reduction of the intracranial pressure. Some patients, however, experience a relatively rapid progression of substantial visual field defects and optic atrophy requiring immediate and effective medicinal treatment. Ophthalmological symptoms are frequently key criteria for idiopathic intracranial hypertension. More attention should be paid to these signs and the diagnostic approach should be multidisciplinary.