AAN 2026 | Guidance for diagnosing idiopathic intracranial hypertension
Muhammad Yousaf, MD, Virginia Tech Carilion School of Medicine, Roanoke, VA, discusses idiopathic intracranial hypertension, a disorder characterized by elevated intracranial pressure, commonly affecting females of childbearing age, with headache being a prevalent symptom. Dr Yousaf emphasizes the importance of a thorough history and physical examination, including fundoscopy, to diagnose the condition. This interview took place at the 78th American Academy of Neurology (AAN) Annual Meeting in Chicago, IL.
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Transcript
Absolutely. So idiopathic intracranial hypertension is a disorder with elevated intracranial pressure. Females who are childbearing age are more susceptible to it. And headache is one of the most common symptoms as well in almost 85% of these patients, which is really kind of a dilemma because this can be easily missed as part of the headache syndrome. But having said that a thorough history and a good physical examination, especially a fundoscopy exam, which can rule in or rule out papilledema, which is the swelling of your optic nerves, can really help us to know what’s going on...
Absolutely. So idiopathic intracranial hypertension is a disorder with elevated intracranial pressure. Females who are childbearing age are more susceptible to it. And headache is one of the most common symptoms as well in almost 85% of these patients, which is really kind of a dilemma because this can be easily missed as part of the headache syndrome. But having said that a thorough history and a good physical examination, especially a fundoscopy exam, which can rule in or rule out papilledema, which is the swelling of your optic nerves, can really help us to know what’s going on. At the same time, there are other symptoms that can occur with it as well, like transient visual obscurations, double vision, diplopia as we say it, and then blind spots then come along as well. Valsalva-triggered headaches or worsening of these headaches. And at the same time, it really affects the functioning of a person because if they lay down or they’re waking in the middle of the night secondary to it the pressure might be actually causing that as well so hence it has an overlap with migraine headaches as well at the same time because you can have photosensitivity you can have phonophobia you can have nausea and vomiting with these headaches as well so again coming back to the roots thorough history is super important in these patients and why it’s important because physical examination other than the swelling in the eyes or sometimes a sixth nerve palsy might not be the only one that we are looking at these could be completely normal otherwise and the brain scans are really helpful other than the lumbar puncture that can help us to make a diagnosis of these patients hence it’s imminent to safeguard their ocular health at the same time while we are getting these diagnostic impressions. And then during the phase of medication and treatment, it does become a little bit challenging over time because we have a very limited toolbox. But having said that, that works well. And in pregnancy, always we have to improvise according to the situation of our patient.
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