Idiopathic intracranial hypertension: Update on diagnosis and management

Abstract

Idiopathic intracranial hypertension is a condition of raised intracranial pressure of unknown cause. Features include new onset headache, which is frequently non-specific; papilloedema is present, visual disturbances are common; and there may be sixth nerve palsy. Diagnosis includes brain imaging with venography to exclude structural causes and venous sinus thrombosis. Lumbar puncture reveals pressure greater than 250 mmCSF with normal constituents. Treatments aim to modify the disease, prevent permanent visual loss and manage headaches. These include weight loss. For those with rapid visual decline, urgent surgical intervention is essential. For most, this is a chronic condition characterised by significantly disabling headaches.

Idiopathic Intracranial Hypertension: Evaluation of Admissions and Emergency Readmissions through the Hospital Episode Statistic Dataset between 2002–2020

“…When compared to the primary care data in the UK, which have previously been published, the incidence over corresponding years is similar. [ 4 ] Likewise, within this cohort there are patients over the age of 65 years ( Figure 2 A), which is not typical of the known phenotype of IIH, described by the IIH literature as a disease that occurs with the major risk factor being weight gain in women of working age [ 1 , 2 , 7 ]. A recent retrospective case series analysis of IIH above the age of 65 years reported that the diagnosis was more commonly seen in males, with incidentally found papilloedema; they had fewer headaches, and on investigation had lower lumbar puncture opening pressure, as compared to IIH controls below the age of 50 years [ 48 ].…”

“…Despite the relative rarity of IIH the multidisciplinary manifestations of the condition lead these patients to access hospital care though a large number of hospital specialties. Headache is the predominant morbidity in over 90% [ 2 , 6 ] and persistent post-IIH headache a challenge to manage [ 7 , 8 ]. Sight loss is not uncommon as typically 7% will require surgical intervention to save vision [ 3 , 9 ].…”

Awareness, Diagnosis and Management of Idiopathic Intracranial Hypertension

“…The most frequent medication used in treating IIH, acetazolamide, is unspecific and is not well tolerated, causing up to half of the patients to discontinue their treatment [ 39 , 40 ]. Topiramate has been tested in an animal study and seemed more efficient than acetazolamide to reduce ICP but so far no randomized controlled human studies are available [ 41 ].…”

“…For many patients topiramate reduces appetite—a side effect than can be helpful in weight reduction. However, adherence to topiramate are likewise hampered by significant side effects as paresthesia, nausea, sedation, taste alteration and kidney stones and cognitive impairment [ 39 , 40 ]. Careful education in symptoms and signs is therefore of immense value for these patients as adherence to medical treatment can be determinant for the beneficial outcome.…”

Navigating migraine care through the COVID-19 pandemic: an update

“…Most can be picked up remotely through systematic questioning (for example sudden onset, worsening or visual symptoms, scalp and temporal tenderness, jaw claudication) and patient access to thermometers and home sphygmomanometers aid assessment. In people with headache, elevated BMI and visual symptoms, urgent ophthalmological assessment is needed, looking for idiopathic intracranial hypertension as headache features may overlap with migraine [ 36 ]. Ophthalmologists and opticians have adapted safe modes of eye examination suitable for the pandemic [ 37 ].…”