UNUSUAL PRESENTATION OF BENIGN INTRACRANIAL HYPERTENSION*t EARLY TREATMENT WITH ORAL GLYCEROL

INCREASED intracranial pressure in the absence of a space-occupying lesion or internal hydrocephalus was first described by Quincke (1893). The condition has since been variously described as serous meningitis (Quincke, 1897; Warrington, 1914; Sheldon, 1933), otitic hydrocephalus (Symonds, 1931), meningeal hydrops (Passot, 1913; Davidoff and Dyke, 1937), pseudotumour (Warrington, 1914), toxic hydrocephalus (McAlpine, 1937), and raised intracranial pressure without brain tumour (Dandy, 1937). The subject has been greatly clarified by Foley (1955), who described 106 cases from the literature and sixty personal cases, dividing them into two main groups: (1) Otitic hydrocephalus with preceding middle ear disease and thrombosis of the major lateral sinus, as suggested by Symonds (1931), and borne out by operative findings, and by sinography (Frenckner, 1937; Ray and Dunbar, 1951). (2) Non-otitic cases, in which the condition was described as benign intracranial hypertension, and which fell into two sub-groups, one with a history of antecedent infection or mild head injury (young age group, with equal sex incidence), and the other with no history of infection, consisting predominantly of females aged 35 to 50, with either obesity or uterine dysfunction. Those cases following infection are also described by Foley as toxic hydrocephalus, although McAlpine (1937) applied this term to cases following nasopharyngeal infection, including cases of otitic hydrocephalus. Bradshaw (1956), in an analysis of 42 cases, described very similar groups, and included them all under the heading of benign intracranial hypertension, a term also used by Davidoff (1956). The essential diagnostic criteria are increased cerebrospinal fluid pressure, with accompanying papilloedema, and the presence of a normal ventricular system. Thus accurate diagnosis has only been possible with the advent of ventriculography (Dandy, 1937; Davidoff and Dyke, 1937), and the term hydrocephalus is inappropriate. There is no good evidence to warrant the name meningeal hydrops, the deep sub-arachnoid space found at craniotomy being an artefact (Foley, 1955). The following case is unusual in that the patient presented with unilateral anterior and posterior uveitis accompanied by transient secondary glaucoma, and went on to develop typical benign intracranial hypertension.