Idiopathic Intracranial Hypertension - Denial or SI?

S

Skyhaul

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Been going round robin with my doctors to satisfy a FAA letter from February requesting follow up documentation after 15 months. See the older thread for the vision issues.

So I completed the last step today by getting a follow-up MRI as requested in the letter. My neurologist called and said that the scans came back as positive for Idiopathic Intracranial Hypertension and negative for MS. He said it’s not a big deal so it’s minor but he thinks this is what’s causing the once a year ocular migraines that has the FAA “concerned”. I have no symptoms beyond a minor visual distortion in one eye that’s correctable to 20/20 and ocular migraines once a year. The neurologist thinks it’s a result of undiagnosed severe obstructive sleep apnea.

I found that Idiopathic Intracranial Hypertension is an automatic deferral with supporting paperwork that has already been requested.

So do I need to redo all the steps or submit everything? What’s the chances of a SI or is this a permanent denial?
 
Idiopathic intracranial hypertension is not a diagnosis made on imaging studies. It is a clinical diagnosis that requires a constellation of symptoms, ocular findings, and a lumbar puncture. I assume your MRI showed small ventricles or "a swollen brain." That does not mean you have the condition. If that is the basis for his diagnosis then you need a new neurologist. If on the other hand you do have the condition based on presentation and clinical findings then you need to be treated, as if left untreated you will not have to worry about flying because you can go blind.
 
douglas393 said:
Idiopathic intracranial hypertension is not a diagnosis made on imaging studies. It is a clinical diagnosis that requires a constellation of symptoms, ocular findings, and a lumbar puncture. I assume your MRI showed small ventricles or "a swollen brain." That does not mean you have the condition. If that is the basis for his diagnosis then you need a new neurologist. If on the other hand you do have the condition based on presentation and clinical findings then you need to be treated, as if left untreated you will not have to worry about flying because you can go blind.
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According to the MRI the ocular nerves mylar is what the neurologist is going off along with the visual field disturbance. But thanks for the information I’ll keep it in mind. He hasn’t said anything about a lumbar puncture as of yet.
 
So Skyhaul....are you a profession aspirant- I'm questioning why you didn't go to BASIC.
 
Skyhaul said:
According to the MRI the ocular nerves mylar is what the neurologist is going off along with the visual field disturbance. But thanks for the information I’ll keep it in mind. He hasn’t said anything about a lumbar puncture as of yet.
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First the ocular nerve better known as the oculomotor nerve or the third cranial nerve(III) has little to do with visual acuity. Dysfunction of the nerve can cause double vision, drooping of the eyelid, and pupillary dilation. Pupillary dilation can cause loss of accommodation (focusing) but that is not really idiopathic intracranial hypertension. The second cranial nerve or optic nerve is what is affected by the condition. Not sure what you mean by mylar.
 
douglas393 said:
First the ocular nerve better known as the oculomotor nerve or the third cranial nerve(III) has little to do with visual acuity. Dysfunction of the nerve can cause double vision, drooping of the eyelid, and pupillary dilation. Pupillary dilation can cause loss of accommodation (focusing) but that is not really idiopathic intracranial hypertension. The second cranial nerve or optic nerve is what is affected by the condition. Not sure what you mean by mylar.
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Perhaps myelin.
 
islandboy said:
Perhaps myelin.
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douglas393 said:
First the ocular nerve better known as the oculomotor nerve or the third cranial nerve(III) has little to do with visual acuity. Dysfunction of the nerve can cause double vision, drooping of the eyelid, and pupillary dilation. Pupillary dilation can cause loss of accommodation (focusing) but that is not really idiopathic intracranial hypertension. The second cranial nerve or optic nerve is what is affected by the condition. Not sure what you mean by mylar.
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Myelin. Apologies autocorrect will be the death of me!

The updated results say: There is mild flattening of the posterior aspect of the globe at the level of the optic discs bilaterally with mild prominence of the CSF space in the optic nerve sheath. These findings could indicate idiopathic intracranial hypertension in the appropriate clinical setting. Please correlate clinically.

bbchien said:
So Skyhaul....are you a profession aspirant- I'm questioning why you didn't go to BASIC.
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I’m currently a commercial pilot and former 121. So I just hold a Second Class nowadays.
 
The mri findings are nonspecific, and are clearly not diagnostic. Unless you have the clinical presentation of the condition I would not put much faith in the mri interpretation. If I was you, my next stop would be to an ophthalmologist preferably a neuro-ophthalmologist who can do a good fundosopic examination (look into your eyes) and see if you have optic nerve issues. If your optic nerves look fine then the diagnosis is spurious. If they are abnormal then this needs to be addressed and passing your medical is not that important. Again, a lot of this also depends on the clinical presentation. Also, I am talking from a medical viewpoint, and the faa medical objectives are very different.
 
Skyhaul said:
Been going round robin with my doctors to satisfy a FAA letter from February requesting follow up documentation after 15 months. See the older thread for the vision issues.

So I completed the last step today by getting a follow-up MRI as requested in the letter. My neurologist called and said that the scans came back as positive for Idiopathic Intracranial Hypertension and negative for MS. He said it’s not a big deal so it’s minor but he thinks this is what’s causing the once a year ocular migraines that has the FAA “concerned”. I have no symptoms beyond a minor visual distortion in one eye that’s correctable to 20/20 and ocular migraines once a year. The neurologist thinks it’s a result of undiagnosed severe obstructive sleep apnea.

I found that Idiopathic Intracranial Hypertension is an automatic deferral with supporting paperwork that has already been requested.

So do I need to redo all the steps or submit everything? What’s the chances of a SI or is this a permanent denial?
Click to expand...
I agree with Douglas about securing an appointment with a neuro-ophthalmologist if there is diagnostic uncertainty.

That said, if in fact you do have pseudotumor cerebri/benign intracranial hypertension (BIH), you will require a special issuance. After satisfying all of the reports/evaluations, it will require a final review by FAA neurology. I worked one of these for an airman last year and they were ultimately certified with special issuance and continued monitoring.
 
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