Awareness, Diagnosis and Management of Idiopathic Intracranial Hypertension

Abstract

The diagnosis and management of idiopathic intracranial hypertension (IIH) can be difficult and multiple medical subspecialities are often involved. Several national and international guidelines regarding the investigations and management of IIH have been published in recent years but still there is no consensus about the optimal organization of IIH-care. The objective of this review was to propose and describe a referral pathway and an organization scheme for diagnosis and management of IIH. An extensive search of existing literature was conducted and summarized. In total, 237 IIH-articles were identified and hereof 43 included. The clinical practice in our specialized IIH-clinic is characterized and described. We conclude that an educational campaign involving medical care providers and patients with chronic headaches is necessary. A detailed organizational proposal for a referral pathway and management of IIH patients based on the literature search and our clinical experience from a highly specialized IIH outpatient clinic is suggested and discussed.

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

“…Optical coherence tomography (OCT) generates non-invasive, high-resolution cross-sectional images of the retina using a near-infrared light source through undilated pupils. OCT is a useful tool to identify and quantify papilledema, along with some details such as an increase of peripapillary retinal nerve fiber layer thickness and peripapillary choroidal and/or retinal folds, proving a true papilledema [ 34 ]. The optic nerve contour, longitudinal assessment of optic nerve swelling, the shape of the back of the eye, and the shape of the scleral opening around the optic nerve are more precisely measurable using OCT. Quantification of the thickness of the retinal ganglion cell layers in the macula is important to alert the clinician that a decrease can reflect irreversible injury to the optic nerve and that the patient is at risk of permanent vision loss [ 26 ].…”

Acetazolamide modulates intracranial pressure directly by its action on the cerebrospinal fluid secretion apparatus

“…paraesthesia, dysgeusia, polyuria and fatigue [ 10 ]. The uncertainty regarding AZE treatment efficiency, combined with poor patient compliance, has raised questions regarding its usability in the clinic [ 11 ]. Notwithstanding, due to lack of alternatives, AZE remains a first-line treatment for certain ICP pathologies, e.g.…”

Evolving Evidence in Idiopathic Intracranial Hypertension

“…Idiopathic intracranial hypertension (IIH) is an enigmatic disorder characterized by raised intracranial pressure (ICP) with no known cause and it affects both children and adults [1]. There is a rising incidence of the condition and it more typically affects women of childbearing age [2,3].…”

“…Diagnosing and managing IIH can be challenging [2] and selected articles underlined the importance of the multidisciplinary team in joint pathways where specialists worked together to provide the best care for patients [1,6,8]. A number of articles investigated methods to aide diagnostic certainty and enable stratification of the disease [9][10][11][12].…”

“…In adults with IIH there are well known co-morbidities such as obesity [1,3], mental health diagnoses [1], polycystic ovarian syndrome [13] and obstructive sleep apnoea [14]. In this issue Jensen et al highlighted a novel observation where 3 non-obese boys diagnosed with IIH also had a diagnosis of autism spectrum disorder [15].…”