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Are Visual Complains, Headaches And Vertigo Signs Of Idiopathic Intracranial Hypertension?

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Posted on Fri, 17 Jul 2015
Question: Could this be Idiopathic intracranial hypertension?

It all began three years ago after I had an episode of branch retinal vein occlusion in my right eye. The cause was never found, but that was just the beginning of strange issues I've had ever since.

For the first year after the incident, I had a constant feeling of pressure in my head. When I sneezed or bend over, I got a strong headache in the back of my skull (that went away slowly after I got up again). Loud tinnitus in my left ear started. The back of my eyes hurt all the time, my ears would get locked like I was in an airplane, constant dizziness sensation. My rhinorrhea (clear fluid dripping out of my nose) also seemed to be getting worse (I've had this issue for years, I take Nasonex for it). My vision was messed up, afterimages, static in vision (visual snow), trouble looking at patterns (some carpets for example).

The second year, things get a bit better. The head pressure sensation went pretty much away. The dizziness lessened. The vision problems were still there, though I didn't pay that much attention to them anymore.

The third year (this year), some of the first year symptoms got back again. The dizziness got worse again. Vision issues are slightly worse (the afterimages especially). New issue: Sudden neck stiffness with a headache (again, seems to originate from the back of my skull). Comes and goes (hasn't happened very often fortunately). One thing that I've been noticing more and more now is that I have a pulsatile tinnitus in my left ear. Gets real loud sometimes and then calms down again.

During the 3 years, numerous things have been ruled out. IIH is one thing that I haven't been tested for though. My CSF opening pressure hasn't been measured. Brain MRI was taken 3 years ago, right after the retinal vein occlusion.

I'm mostly worried about my vision. (Usually) slow vision loss in IIH seems to be the biggest thing to worry if one has that. I wonder if my retinal vein occlusion episode could have something to do with this as well. Finally, I'm pretty sure it's just vasomotor rhinitis, but I've also read about CSF Rhinorrhea. The fluid that comes out of my nose constantly is clear. I wonder I wonder..

Do you think I should get my opening pressure tested? Any other ideas? Thanks!
doctor
Answered by Dr. Neeraj Kumar (1 hour later)
Brief Answer:
Proper evaluation required

Detailed Answer:
hello XXXX,
I have gone through your queries and understand your concerns.
Visual complains, headche, clear nasal discharge and tinnitus with or without vertigo are your major complains.
Regarding possibilties of diagnosis
1) Low pressure hydrocephalous-- Features of headache , clear nasal discharge(? CSF rhinorrhea). To be evaluated by CSF manometry, MRI brain and csf scintigraphy study.
2) Idiopathic intracranila hypertension-- Features of headache , visual loss may be suggestive. To be evaluated by CSF manometry, MRI brain and MRV and coagulation profile.
3) Vasculitis-- Requires evaluation and detailed workup by expert neurologist.
I would advice you to visit a neurologist for proper evaluation and treatment accordingly.
Hope you found the answer helpful.
Do get back for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Neeraj Kumar (46 minutes later)
Thank you for your advice!

Vasculitis was one main thing doctors suspected when the retinal vein occlusion happened. That was ruled out after several tests & studies (this was in 2012). Coagulation profile was also taken at that time (no problem there).

I'll make an appointment with my local neurologist and ask for the CSF tests you mentioned. Looks like it's worth checking to be on the safe side.

Thanks again and have a great day!
doctor
Answered by Dr. Neeraj Kumar (46 minutes later)
Brief Answer:
Follow up after appointment with neurologist

Detailed Answer:
Hello XXXX,
Hoping for your best. May your appointment with neurologist be successful in terms of definite diagnosis.
God bless you.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
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Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2259 Questions

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Are Visual Complains, Headaches And Vertigo Signs Of Idiopathic Intracranial Hypertension?

Brief Answer: Proper evaluation required Detailed Answer: hello XXXX, I have gone through your queries and understand your concerns. Visual complains, headche, clear nasal discharge and tinnitus with or without vertigo are your major complains. Regarding possibilties of diagnosis 1) Low pressure hydrocephalous-- Features of headache , clear nasal discharge(? CSF rhinorrhea). To be evaluated by CSF manometry, MRI brain and csf scintigraphy study. 2) Idiopathic intracranila hypertension-- Features of headache , visual loss may be suggestive. To be evaluated by CSF manometry, MRI brain and MRV and coagulation profile. 3) Vasculitis-- Requires evaluation and detailed workup by expert neurologist. I would advice you to visit a neurologist for proper evaluation and treatment accordingly. Hope you found the answer helpful. Do get back for further queries. Regards Dr Neeraj Kumar Neurologist