The U-M Health neurointerventional team has been established in the practice of minimally invasive treatment of neurovascular disease in adult and pediatric populations for more than two decades. The team provides unparalleled expertise and the most advanced diagnosis and treatment methods for patients with idiopathic intracranial hypertension. In conjunction with our neuro-ophthalmology colleagues, the condition is diagnosed and conservatively treated.

In select cases with no improvement or with intolerance to conservative management, venous stenting may be an appropriate option to reduce intracranial pressure.

Through close collaboration, the neurointerventional and neuro-ophthalmological team at U-M Health strives to provide individualized care for each patient while helping to educate and guide patients through the pathway of diagnosis and treatment.

To make an appointment with our neuro-ophthalmology team, call 734-764-4190.

Symptoms of idiopathic intracranial hypertension include:

• Severe headaches
• Pulsatile tinnitus (a whooshing sound in the ear)
• Transient visual loss, particularly with changes in position
• Vision loss
• Double vision
• Blind spots
• Neck and shoulder pain
• Peripheral (side) vision loss

An evaluation, including a complete eye exam, by a skilled neuro-ophthalmologist is generally the first step toward a diagnosis of idiopathic intracranial hypertension.

IIH is suspected when swollen optic nerves at the back of the eye are detected. This condition is known as papilledema. Visual field tests may also be conducted to determine if there are blind spots in a patient’s vision.

Additional tests typically include:

• Brain imaging, such as an MRI or angiogram to rule out conditions that can present with similar symptoms, including a blood clot, vascular abnormality or brain tumor, among others.
• Lumbar puncture (spinal tap) to measure pressure inside the skull and to determine the amount of cerebrospinal fluid in the brain. If the pressure reading is above 20-30 cm of H2O, accompanied by swelling in the optic nerve at the back of the eye, idiopathic intracranial hypertension is often the cause, having excluded other issues

Treatment for IIH depends on test results that indicate too much CSF being produced in the brain or an issue with the amount of fluid being absorbed into the bloodstream.

A multidisciplinary team with expertise in IIH will determine the appropriate treatment method, which may include:

• Weight loss if obesity is a factor.
• Medications to help reduce the production of CSF and improve symptoms. Diuretics can also help reduce fluid retention and migraine medication may be prescribed to help reduce headaches.

Surgical Options

• Optic nerve sheath fenestration - An opening is made into the membrane surrounding the optic nerve, allowing excess cerebrospinal fluid to escape and reduce pressure on the optic nerve.
• Spinal fluid shunt - A thin tube, or shunt, is inserted into the brain to drain excess cerebrospinal fluid.
• Venous sinus stenting - This minimally invasive endovascular procedure is performed when imaging indicates narrowing of one of the brain venous sinuses — the large veins that return blood from the brain to the heart. The condition is known as venous sinus stenosis. The team evaluates the pressure gradient across the area of narrowing using an angiogram. When the measurement is significant (greater than 8 mm of HG), stent placement may be recommended. During the procedure, a stent is placed in the affected vein to normalize the pressure gradient. Blood thinners are needed after the procedure.