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==Overview==
==Overview==
==Physical Examination==
==Physical Examination==
Physical examination of patients with [pseudotumor cerebri is usually remarkable for Papilledema, Visual field loss and Sixth nerve palsy.
Physical examination of patients with pseudotumor cerebri is usually remarkable for:
 
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
 
===Vital Signs===
 
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* Papilledema: [[Papilledema]] is very common in [[Idiopathic intracranial hypertension|IIH]] patients but because of anatomic differences or early presentation of the disease it may be absent in some patients. The [[papilledema]] from [[Idiopathic intracranial hypertension|IIH]] disease is mostly bilateral and symmetric, but in some cases unilateral and asymmetric [[papilledema]] can happen.<ref name="pmid1774176">{{cite journal |vauthors=Chari C, Rao NS |title=Benign intracranial hypertension--its unusual manifestations |journal=Headache |volume=31 |issue=9 |pages=599–600 |date=October 1991 |pmid=1774176 |doi= |url=}}</ref> there is a relationship between the severity of [[papilledema]] and the chance of losing eye vision permanently.<ref name="pmid9430554">{{cite journal |vauthors=Wall M, White WN |title=Asymmetric papilledema in idiopathic intracranial hypertension: prospective interocular comparison of sensory visual function |journal=Invest. Ophthalmol. Vis. Sci. |volume=39 |issue=1 |pages=134–42 |date=January 1998 |pmid=9430554 |doi= |url=}}</ref> On funduscopic evaluation we can see [[papilledema]], macular exudates and [[Macular edema|edema]], choroidal folds across the [[macula]], [[choroidal neovascularization]] and elevation of serous retinal around the [[nerve head]].<ref name="pmid17242038">{{cite journal |vauthors=Acheson JF |title=Idiopathic intracranial hypertension and visual function |journal=Br. Med. Bull. |volume=79-80 |issue= |pages=233–44 |date=2006 |pmid=17242038 |doi=10.1093/bmb/ldl019 |url=}}</ref>
OR
* visual loss: [[Vision loss]] is very common in [[Idiopathic intracranial hypertension|IIH]] patients. It happens as [[visual field]] loss then progress to [[visual acuity]].<ref name="pmid1998880">{{cite journal |vauthors=Wall M, George D |title=Idiopathic intracranial hypertension. A prospective study of 50 patients |journal=Brain |volume=114 ( Pt 1A) |issue= |pages=155–80 |date=February 1991 |pmid=1998880 |doi= |url=}}</ref><ref name="pmid11453440">{{cite journal |vauthors=Salman MS, Kirkham FJ, MacGregor DL |title=Idiopathic "benign" intracranial hypertension: case series and review |journal=J. Child Neurol. |volume=16 |issue=7 |pages=465–70 |date=July 2001 |pmid=11453440 |doi=10.1177/088307380101600701 |url=}}</ref>
* Abnormalities of the head/hair may include ___
* [[Sixth nerve palsy]]: The abducens nerve palsy can happen in [[Idiopathic intracranial hypertension|IIH]] patients in unilateral or bilateral manner.<ref name="pmid24756302">{{cite journal |vauthors=Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, McDermott MP |title=The idiopathic intracranial hypertension treatment trial: clinical profile at baseline |journal=JAMA Neurol |volume=71 |issue=6 |pages=693–701 |date=June 2014 |pmid=24756302 |pmc=4351808 |doi=10.1001/jamaneurol.2014.133 |url=}}</ref>
* Evidence of trauma
* Other cranial nerve deficits: In some case report the palsy of these nerves was noted:
* Icteric sclera
# [[Olfactory]]<ref name="pmid23794685">{{cite journal |vauthors=Kunte H, Schmidt F, Kronenberg G, Hoffmann J, Schmidt C, Harms L, Goektas O |title=Olfactory dysfunction in patients with idiopathic intracranial hypertension |journal=Neurology |volume=81 |issue=4 |pages=379–82 |date=July 2013 |pmid=23794685 |doi=10.1212/WNL.0b013e31829c5c9d |url=}}</ref>
* [[Nystagmus]]  
# [[Oculomotor]]<ref name="pmid1774176">{{cite journal |vauthors=Chari C, Rao NS |title=Benign intracranial hypertension--its unusual manifestations |journal=Headache |volume=31 |issue=9 |pages=599–600 |date=October 1991 |pmid=1774176 |doi= |url=}}</ref>
* Extra-ocular movements may be abnormal
# [[Trochlear nerve]]<ref name="pmid9534686">{{cite journal |vauthors=Soler D, Cox T, Bullock P, Calver DM, Robinson RO |title=Diagnosis and management of benign intracranial hypertension |journal=Arch. Dis. Child. |volume=78 |issue=1 |pages=89–94 |date=January 1998 |pmid=9534686 |pmc=1717437 |doi= |url=}}</ref>
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
# [[Trigeminal nerve]]<ref name="pmid1774176">{{cite journal |vauthors=Chari C, Rao NS |title=Benign intracranial hypertension--its unusual manifestations |journal=Headache |volume=31 |issue=9 |pages=599–600 |date=October 1991 |pmid=1774176 |doi= |url=}}</ref>
*Ophthalmoscopic exam may be abnormal with findings of ___
# [[Facial nerve]]<ref name="pmid1475750">{{cite journal |vauthors=Lessell S |title=Pediatric pseudotumor cerebri (idiopathic intracranial hypertension) |journal=Surv Ophthalmol |volume=37 |issue=3 |pages=155–66 |date=1992 |pmid=1475750 |doi= |url=}}</ref>
* Hearing acuity may be reduced
# [[Auditory nerve]]<ref name="pmid15793399">{{cite journal |vauthors=Rudnick E, Sismanis A |title=Pulsatile tinnitus and spontaneous cerebrospinal fluid rhinorrhea: indicators of benign intracranial hypertension syndrome |journal=Otol. Neurotol. |volume=26 |issue=2 |pages=166–8 |date=March 2005 |pmid=15793399 |doi= |url=}}</ref>
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 17:37, 8 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Physical Examination

Physical examination of patients with pseudotumor cerebri is usually remarkable for:

HEENT

  • Papilledema: Papilledema is very common in IIH patients but because of anatomic differences or early presentation of the disease it may be absent in some patients. The papilledema from IIH disease is mostly bilateral and symmetric, but in some cases unilateral and asymmetric papilledema can happen.[1] there is a relationship between the severity of papilledema and the chance of losing eye vision permanently.[2] On funduscopic evaluation we can see papilledema, macular exudates and edema, choroidal folds across the macula, choroidal neovascularization and elevation of serous retinal around the nerve head.[3]
  • visual loss: Vision loss is very common in IIH patients. It happens as visual field loss then progress to visual acuity.[4][5]
  • Sixth nerve palsy: The abducens nerve palsy can happen in IIH patients in unilateral or bilateral manner.[6]
  • Other cranial nerve deficits: In some case report the palsy of these nerves was noted:
  1. Olfactory[7]
  2. Oculomotor[1]
  3. Trochlear nerve[8]
  4. Trigeminal nerve[1]
  5. Facial nerve[9]
  6. Auditory nerve[10]




References

  1. ↑ 1.0 1.1 1.2 Chari C, Rao NS (October 1991). "Benign intracranial hypertension--its unusual manifestations". Headache. 31 (9): 599–600. PMID 1774176.
  2. ↑ Wall M, White WN (January 1998). "Asymmetric papilledema in idiopathic intracranial hypertension: prospective interocular comparison of sensory visual function". Invest. Ophthalmol. Vis. Sci. 39 (1): 134–42. PMID 9430554.
  3. ↑ Acheson JF (2006). "Idiopathic intracranial hypertension and visual function". Br. Med. Bull. 79-80: 233–44. doi:10.1093/bmb/ldl019. PMID 17242038.
  4. ↑ Wall M, George D (February 1991). "Idiopathic intracranial hypertension. A prospective study of 50 patients". Brain. 114 ( Pt 1A): 155–80. PMID 1998880.
  5. ↑ Salman MS, Kirkham FJ, MacGregor DL (July 2001). "Idiopathic "benign" intracranial hypertension: case series and review". J. Child Neurol. 16 (7): 465–70. doi:10.1177/088307380101600701. PMID 11453440.
  6. ↑ Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, McDermott MP (June 2014). "The idiopathic intracranial hypertension treatment trial: clinical profile at baseline". JAMA Neurol. 71 (6): 693–701. doi:10.1001/jamaneurol.2014.133. PMC 4351808. PMID 24756302.
  7. ↑ Kunte H, Schmidt F, Kronenberg G, Hoffmann J, Schmidt C, Harms L, Goektas O (July 2013). "Olfactory dysfunction in patients with idiopathic intracranial hypertension". Neurology. 81 (4): 379–82. doi:10.1212/WNL.0b013e31829c5c9d. PMID 23794685.
  8. ↑ Soler D, Cox T, Bullock P, Calver DM, Robinson RO (January 1998). "Diagnosis and management of benign intracranial hypertension". Arch. Dis. Child. 78 (1): 89–94. PMC 1717437. PMID 9534686.
  9. ↑ Lessell S (1992). "Pediatric pseudotumor cerebri (idiopathic intracranial hypertension)". Surv Ophthalmol. 37 (3): 155–66. PMID 1475750.
  10. ↑ Rudnick E, Sismanis A (March 2005). "Pulsatile tinnitus and spontaneous cerebrospinal fluid rhinorrhea: indicators of benign intracranial hypertension syndrome". Otol. Neurotol. 26 (2): 166–8. PMID 15793399.

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