Treatment and Monitoring of Idiopathic Intracranial Hypertension

This article reviews the management of idiopathic intracranial hypertension (IIH), which is essential to neurology practice.

The incidence and prevalence of IIH have risen because of the worldwide obesity epidemic. Evidence suggests that IIH has a unique systemic metabolic phenotype. Clinical history, examination, and visual fields remain the cornerstone for monitoring people with IIH. Optical coherence tomography demonstrates structural changes that aid decision-making. The principles of IIH management include protecting vision and escalating to surgical interventions when it is threatened, addressing the role of obesity in the condition, and providing advice on headache therapeutics. There are no labeled therapies for IIH; however, acetazolamide remains the most common medication prescribed. A glucagon-like peptide-1 receptor agonist was recently shown to reduce intracranial pressure independent of weight reduction in a phase II randomized controlled trial in people with IIH, suggesting it could be a promising treatment for IIH. In patients with IIH requiring surgery, there has been an increase in venous sinus stenting.

Neurologists are central in the management pathway for people with IIH. Ongoing coordinated care between ophthalmologists and neurologists is essential for optimal care of these patients.