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Table 1 Criteria to diagnose IIH

From: Idiopathic intracranial hypertension with multiple cranial nerve palsies in 10 years old thin Sudanese boy: case report

For a diagnosis of IIH to be made, all five criteria must be fulfilled

1. Normal neurologic examination except for cranial nerve abnormalities (typically VI nerve/s)

2. Presence of papilledema

3. Normal brain neuroimaging (no evidence of hydrocephalus, mass or structural lesion, and no abnormal meningeal enhancement on magnetic resonance imaging). Typical radiological features of stigmata of raised intracranial pressure.

4. Normal cerebrospinal fluid composition

5. Raised lumbar puncture opening pressure (≥ 250 mmHg in adults and ≥ 280 mmHg in children (250 mmHg if the child is not sedated and not obese)) in a properly performed lumbar puncture

Diagnosis of IIH without papilledema

➢ In the absence of papilledema, a diagnosis of IIH syndrome can be made if 2–5 from above are satisfied, and in addition the patient has unilateral or bilateral abducens nerve palsy.

➢ In the absence of papilledema or sixth nerve palsy, a diagnosis of IIH syndrome can be suggested but not made if 2–5 from above are satisfied, and in addition at least 3 of the following neuroimaging criteria are satisfied:

A. Empty sella

B. Flattening of the posterior aspect of the globe

C. Distention of the perioptic subarachnoid space with or without a tortuous optic nerve

D. Transverse venous sinus stenosis

➢ A diagnosis of IIH is definite if the patient fulfills criteria 1–5.

➢ The diagnosis is considered probable if criteria 1–4 are met but the measured CSF pressure is lower than specified for a definite diagnosis.