Reviewing the Recent Developments in Idiopathic Intracranial Hypertension

Abstract

There is increasing evidence and appreciation of idiopathic intracranial hypertension (IIH) in medicine. The pathological processes underlying raised intracranial pressure are being studied, with new insights found in both hormonal dysregulation and the metabolic neuroendocrine axis. These will potentially lead to novel therapeutic targets for IIH. The first consensus guidelines have been published on the investigation and management of adult IIH, and the International Headache Society criteria for headache attributable to IIH have been modified to reflect our evolving understanding of IIH. Randomized clinical trials have been published, and a number of studies in this disease area are ongoing.

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 ].…”

“…Changing awareness of the condition due to publication of the IIH guidelines [ 23 , 24 ] and emerging evidence [ 1 , 2 ] could have influenced the trends, in particular, the recommendation that CSF shunting should only be performed for sight threatening disease and not headache symptoms. Similarly, recommendations for medical headache management could have possibly reduced the number of those who had previously been admitted for repeat lumbar punctures or sought surgery for management.…”

“…Idiopathic Intracranial Hypertension (IIH) is characterized by an elevation of intracranial pressure (ICP) with no identifiable cause [ 1 , 2 ]. There is a rising incidence in this disease, and it appears that the incidence is related to country specific prevalence of obesity [ 3 , 4 , 5 ].…”

“…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 ].…”

The Health Economic Evaluation of Bariatric Surgery Versus a Community Weight Management Intervention Analysis from the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT)

“…Idiopathic intracranial hypertension (IIH) causes challenging headaches, visual loss, and reduced quality of life [ 1 ]. Hospital costs for IIH admissions have been found to be four times greater than for a general population-based per person admission [ 2 ].…”