High Intracranial Pressure Treatment
Idiopathic Intracranial Hypertension (“IIH”)
Could you have high intracranial pressure?
Normally, the brain floats in a bath of fluid (cerebrospinal fluid). This fluid surrounds the brain with nutrients, allows the drainage of wastes, and cushions the delicate brain from impact.
Cerebrospinal fluid (or CSF) is always being produced, and always being drained. When this delicate balance is interrupted for any reason, and the fluid pressure increases, symptoms occur.
Symptoms resulting from this fluid imbalance can be vague, and easily confused with other diagnoses. Some common symptoms include:
Dizziness Nausea Neck Pain Sleep Disturbances Headaches Flushing Vision changes
Often, these symptoms can worsen when lying down. Some patients can wake up at night with a fast heart rate and they may feel hot, sweaty, and even panicky. It can seem like anxiety or a bad dream, when it is actually the brain alerting the body that the brain cannot get enough oxygen!
These can all be symptoms of high intracranial pressure, but not all symptoms affect everyone and the symptoms can be easily misinterpreted.
What does it feel like to have high intracranial pressure?
Some patients are diagnosed with chronic migraines. Because both migraine headaches and headaches due to high intracranial pressure (IIH) can both occur with nausea, the diagnosis can be missed.
Some patients can be so severely affected they have daily headaches for years, with little or no relief from medication. Some have persistent neck pain and stiffness and may have been told they need neck fusions or Botox injections – yet they continue to suffer, or worsen over time.
Some patients are told their symptoms may be due to a spinal leak and undergo invasive testing that (ironically) can increase the risk of spinal leaks later. If spinal leaks are secondary to high pressure, it is always best to treat the high pressure first (and after treatment for the leak). If this is ignored, the leak repair can fail, and patients stay symptomatic.
Some patients with undiagnosed high intracranial pressure can go on to develop CSF leaks (out of their noses, ears, or spines). When the fluid pressure builds up, the fluid needs to go somewhere! If there are areas of weakness in the lining of the brain or spinal cord, the chance of a leak increases. This is more common in patients with connective tissue disorders (such as Ehlers-Danlos syndrome) or patients with bone spurs on the spine.
For this reason, high intracranial pressure treatment is critical to try to avoid leaks later in life.
It is critical to recognize and treat high intracranial pressure, as this is the only way for most patients to get resolution of these symptoms and to avoid unnecessary and risky procedures.
Diagnosis and treatment of IIH can be tricky. At POTS Care, we are experts at identifying and treating IIH, and we always evaluate patients non-invasively.
At POTS Care, we are experts in Idiopathic Intracranial Hypertension (IIH). IIH can be difficult to detect without swelling of the optic nerve head (papilledema), so careful evaluations of brain MRI’s, signs and symptoms, and some unique ocular testing is necessary. We can perform fundus evaluations, Ocular Coherence Tomography, ultrasounds of the optic nerve, and additional unique, non-invasive ocular testing to get the answers you need.
How did we get to be the experts?
Fourteen years ago, Dr. Diana Driscoll (Clinical Director) was disabled by POTS/EDS (Postural Orthostatic Tachycardia Syndrome/Ehlers-Danlos syndrome), as were her children. After seeking help from physicians across the United States, it was recommended that she undergo Chiari surgery, a neck fusion, and ultimately, a brain shunt. The same was recommended for her son, who was then 8 years old.
Being an eye doctor (comfortable with the diagnosis and treatment of IIH or pseudotumor cerebri), and fearful of the consequences of invasive neurosurgery, she explored all options for treatment. Eventually, she recognized the problem as IIH, but without the typical sign of papilledema. Treatment was tricky, but they were ultimately able to avoid invasive procedures, go into remission, and learn how to control their propensity for this high pressure.
Eye doctors have specialized equipment that can help with the non-invasive testing for IIH. The fluid that cushions the brain and allows it to float, is also found around the optic nerve. This unique anatomy of the eye allows for an evaluation that is not possible with any other part of the body. The eye can be the window to abnormal intracranial pressure, but traditional views of the optic nerve to look for swelling (papilledema) are usually insufficient.
From Dr. Driscoll:
I’ve come to learn that many more people suffer with IIH than we presumed in the past. Doctors generally think of high intracranial pressure as being constant – either it is there or it isn’t. Instead, we’ve found that it can come and go, making diagnosis difficult. Doctors often think that headaches are a necessary consequence of IIH, which is also not true. Patients don’t usually show dramatic papilledema (swelling of the optic nerve), and evidence of IIH is not always seen on an MRI – making it more of an “invisible” IIH. Although lumbar punctures are considered the gold standard for diagnosis, many patients have connective tissue disorders, and should avoid lumbar punctures whenever possible. These patients are more prone to spinal leaks that can be secondary to high pressure or secondary to the lumbar punctures themselves. Relying on lumbar punctures is an antiquated mistake that can be avoided. Most patients with IIH suffer for years and even lifetimes, never getting the help they need. Or worse, take unnecessary medications and undergo risky procedures. I not only lived this, but I see it every day at POTS Care. We are here to change this!
POTS Care is now open to patients for the evaluation and treatment of high intracranial pressure.
We understand that most patients come to us from quite a distance, so we will try to get all of the information we need from you in one visit, then provide follow-up over the phone (a package with package pricing). If you are local or can come to us for a few visits, you may prefer our hourly rate options.
Please call for more information or to schedule your visit at 1-866-349-9905
We are located in Colleyville, close to DFW International Airport.