Idiopathic Intracranial Hypertension (IH)

Do you also have an unbearable headache and a change in your vision? Sometimes you feel like you hear a ringing in your ears or see two things in your eyes? Although many people think that this is a normal migraine, sometimes the cause of this can be a special condition that increases the pressure inside our head. Although this may seem a little scary, if you understand it properly and treat it on time, it can be well controlled. Today we are going to talk about this condition that many people do not know about, but it is very important to know.

Simply put, what is Idiopathic Intracranial Hypertension (IIH)?

This name sounds a bit complicated, doesn't it? Let's break it down word by word and understand it.

• Idiopathic : This means "no known cause." This means that doctors are still trying to find the exact cause of the disease.
• Intracranial: This means "within the skull."
• Hypertension: This means "high blood pressure."

Simply put, Idiopathic Intracranial Hypertension (IIH) is an increase in pressure inside the head without any apparent cause.

Think about it, our brain is not just something inside the skull. There is a special fluid around it to protect it. We call this Cerebrospinal Fluid (CSF) . This CSF fluid is what protects our brain and spinal cord from hitting each other and colliding. This CSF fluid is constantly produced inside our body, and it is also reabsorbed by the body. Just like a tank is filled with water, and water flows out the other side.

In IIH, for some reason, this CSF fluid is either produced too much or is not properly reabsorbed back into the body. This causes this fluid to accumulate inside the skull and gradually increase in pressure. This increased pressure can affect not only our brain, but also the optic nerve that helps our eyes see.

What are the symptoms of someone with IIH?

A person with this condition can experience various symptoms. But these are the main and most common symptoms. Let's look at this in a table to understand it clearly.

Since these symptoms can also be seen in other diseases, if you experience something like this, it is best to definitely see a doctor and seek advice.

Why does this condition occur? What are the risk factors?

As we mentioned earlier, the exact cause of this is unknown, but doctors believe that this pressure may be caused by a blockage in the pathways that carry CSF fluid or a narrowing of the large veins (venous sinuses) in the brain.

Although this condition can develop in anyone, some people are more likely to develop it. Let's take a look at who they are.

• Women: This condition is more common in women than men, especially women of childbearing age (between 20-45 years old).
• Overweight: People who are overweight for their height, meaning those with a Body Mass Index (BMI) of over 30, are at a much higher risk of developing IIH. Researchers say that excess fat in the abdomen and chest can make it harder for blood to flow down to the brain, causing fluid to build up inside the brain.
• Heredity: Some studies show that if someone in the family has it, there is a small chance that others will also develop it. However, research is still ongoing on this.

Is this serious? Can complications occur?

This may sound scary, but IIH is not actually a life-threatening disease. That means it doesn't kill you.

However, the main and most serious complication of this is permanent loss of vision. This is because the increased pressure inside the head directly affects our optic nerve. If this nerve is damaged for a long time, it cannot be repaired. Therefore, permanent loss of vision can occur.

How does the doctor diagnose this disease exactly?

When you go to see a doctor, he or she will first ask you about your symptoms and then order a series of tests to rule out other conditions that may have similar symptoms.

• Eye exam: An ophthalmologist will examine your eyes carefully, especially to check for swelling of the optic nerve. They will also perform a visual field test to check for blind spots in your field of vision.
• Brain scans: A CT scan or MRI scan may be ordered to make sure there is no other serious cause, such as a brain tumor.
• Spinal tap / Lumbar puncture:Some people are scared when they hear this name. But this is a very important test for diagnosis. What you do is insert a small needle into the lower back, take out a little of that CSF fluid we talked about, and measure its pressure. This pressure is much higher than normal in someone with IIH.

If all of these tests are done and no other cause is found and the CSF pressure is also high, your doctor will confirm that you have IIH.

What are the treatments for this?

IIH treatment has two main goals. One is to reduce pressure inside the brain. The other is to prevent vision loss. Depending on the severity of your condition, your doctor may recommend one or more treatments.

Medications

Often, treatment begins with medication.

• Medications that reduce CSF production: Medications such as acetazolamide or topiramate are given to reduce the body's production of CSF fluid.
• Diuretics: These help reduce blood pressure by removing excess fluid from the body through urine.
• Painkillers: General painkillers are given to control headaches.

If you are pregnant, trying to get pregnant, or taking birth control pills, you should definitely tell your doctor, as some medications may not be suitable for those situations.

Surgery

In severe cases that cannot be controlled with medication, or that severely affect vision, surgery may be necessary.

• Shunt placement: This involves allowing excess CSF fluid to flow through a thin tube to another location, such as the abdominal cavity.
• Stent placement: If a vein (venous sinus) in the brain has narrowed, a small mesh-like tube (stent) is inserted into it to widen it. This allows blood flow to be improved and the pressure to be reduced.
• Optic nerve sheath fenestration: This is an eye surgery that involves making several small holes in the sheath surrounding the optic nerve, allowing the CSF that has accumulated there to drain.

Weight Management

This is a very important step in both treatment and prevention of relapse. If your BMI is over 30, your doctor will likely advise you to lose weight. Research has shown that losing just 5% to 10% of your body weight can significantly improve IIH symptoms. It can be helpful to work with a nutritionist to help you with this.

What happens next? How can I live with this?

If diagnosed early and treated properly, most people with IIH can live normal lives. Although there is no cure, it is a manageable condition.

This means you may have to deal with it for the rest of your life. Sometimes the symptoms may go away and then come back. So it's very important to follow your doctor's treatment plan, especially weight control.

Once you've been diagnosed with IIH, don't miss your regular follow-up visits with your doctor and ophthalmologist. It's essential to protect your eyesight.