Idiopathic Intracranial Hypertension

Abstract

Idiopathic intracranial hypertension (IIH) is primarily a disease of overweight women of childbearing age but it can affect any weight, sex or age. It is a potential cause of blindness and is associated with reduced quality of life due to visual loss, headaches and depression. It consumes significant healthcare resources related to monitoring and treatment. The overall incidence is increasing, probably related to the global increase in obesity. While many conditions can be associated with the syndrome, the cause of IIH remains unknown and the optimal treatment remains uncertain. Typical symptoms include headache, transient visual obscurations, tinnitus and diplopia, though it may be asymptomatic. Papilloedema is essential for the diagnosis of IIH, though IIH without papilloedema (IIHWOP) is a recognised entity. The diagnosis is based on clinical findings, detailed ophthalmic evaluation, imaging (ideally MRI), and lumbar puncture. The cerebrospinal fluid contents must be normal and the opening pressure be above 25 cm H2O in adults and 28 cm H2O in children. The optimal treatment remains uncertain, but options include weight loss, acetazolamide, topiramate, lumbo-peritoneal shunting, optic nerve sheath fenestration and cerebral venous sinus stenting. Bariatric surgery may also help achieve weight loss. Show more