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Update on Idiopathic Intracranial Hypertension
Sivashakthi Kanagalingam1, Prem S Subramanian2,3,4
1Department of Surgery, Division of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Current Treatment Options in Neurology
|May 30, 2018
Summary
Acetazolamide offers additional benefits for mild idiopathic intracranial hypertension (IIH) beyond weight loss. For severe IIH, surgical options and venous sinus stenting are effective, though headache relief varies.
Area of Science:
- Neurology
- Ophthalmology
- Neurosurgery
Background:
- Idiopathic intracranial hypertension (IIH) presents diagnostic and therapeutic challenges.
- Current treatment strategies require critical appraisal based on recent evidence.
Purpose of the Study:
- To review and critically appraise current therapeutic strategies for idiopathic intracranial hypertension (IIH).
- To provide recommendations on treatment initiation and escalation for IIH patients.
- To identify knowledge gaps in therapeutic efficacy and comparative superiority of interventions.
Main Methods:
- Review of recent evidence supporting medical and surgical interventions for IIH.
- Analysis of findings from the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT).
- Evaluation of uncontrolled interventional studies on transverse sinus stenting.
Main Results:
- Acetazolamide therapy demonstrated additional efficacy compared to weight loss alone in mild IIH (IIHTT).
- Headache management in IIH may require treatments beyond intracranial pressure (ICP) lowering.
- Transverse sinus stenting shows potential as an effective treatment for medically refractory IIH.
Conclusions:
- Medical therapy with acetazolamide should complement weight loss for mild IIH.
- Surgical options (optic nerve sheath fenestration, CSF diversion) are available for vision-threatening IIH.
- Venous sinus stenting is an emerging alternative therapy; headache relief from ICP lowering is variable.
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