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Update on Idiopathic Intracranial Hypertension

  • Neurologic Ophthalmology and Otology (RK Shin and DR Gold, Section Editors)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another.

Recent findings

A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial—IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone. Furthermore, management of IIH-related headache, even in patients with papilledema, may require treatment other than ICP lowering for patients to experience symptomatic relief. Finally, a number of uncontrolled interventional studies have shown transverse sinus stenting to be a potentially effective treatment for medically refractory IIH.

Summary

Medical therapy with acetazolamide should be considered in addition to structured weight loss in patients with mild IIH. Surgical treatment for patients with vision-threatening disease IIH can be performed by either optic nerve sheath fenestration or cerebrospinal fluid diversion, with venous sinus stenting emerging as an alternate therapy. Headache relief from ICP lowering therapy is variable and often not sustained.

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Authors and Affiliations

  1. Department of Surgery, Division of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Sivashakthi Kanagalingam MD

  2. Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, 1675 Aurora Court, Mailstop F-731, Aurora, CO, 80045, USA

    Prem S. Subramanian MD, PhD

  3. Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Prem S. Subramanian MD, PhD

  4. Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Prem S. Subramanian MD, PhD

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  1. Sivashakthi Kanagalingam MD
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Correspondence to Prem S. Subramanian MD, PhD.

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Sivashakthi Kanagalingam declares that she has no potential conflicts of interest.

Prem S. Subramanian is supported in part by a Challenge Grant to the Department of Ophthalmology, University of Colorado School of Medicine, from Research to Prevent Blindness, Inc.

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Kanagalingam, S., Subramanian, P.S. Update on Idiopathic Intracranial Hypertension. Curr Treat Options Neurol 20, 24 (2018). https://doi.org/10.1007/s11940-018-0512-7

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