Idiopathic Intracranial Hypertension – Pathophysiology Based on Case Series

Abstract

According to the definition, idiopathic intracranial hypertension (IIH) is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it.We present an overview of possible etiopathogenetic mechanisms, clinical presentations and therapeutic interventions from a series of patients hospitalized with the clinical picture and final diagnosis of idiopathic intracranial hypertension (IIH). All data were collected from the moment of IIH diagnosis as well as three months later.The obtained data showed that IIH is a disease that primarily affects obese women in early and midlife. The positive correlation between values of cerebrospinal fluid pressure and body mass index was observed. The disorders of sexual hormones were identified as a possible etiology for IIH female patients. Headache, papilloedema, decreased visual acuity, vertigo and cranial nerve palsy were identified as the most prevalent IIH clinical presentations. The existence of stenosis and hypoplasia of the sigmoid and transverse sinus were confirmed only in one third of IIH patients. Pharmacotherapy combined with weight loss was efficacious in a large number of patients. In this series, there were no short-term consequences of IIH.The results suggest the importance of early and accurate looking for IIH in obese early and midlife women with any hormonal imbalances having a variety of neurological expression, mostly presented as headaches and visual disturbances. Early detection of IIH might influence the timely treatment and prevent far-reaching and severe clinical consequences. Key words: idiopathic intracranial hypertension, headache, pathophysiology O r i g i n a l a r t i c l e I NT ROD U CT I ONAccording to the definition, idiopathic intracranial hypertension (IIH) is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it (1, 2).It is widely accepted that IIH usually affects patients who are between 20 and 40 years of age and is combined with obesity. Nevertheless, there are cases when IIH occurs even earlier, although it is not then generally accompanied by obesity (3). Women are more affected than men, 4 to even 15 times, as has been estimated (4). The frequency of IIH occurrence is 1-2 per 100.000 of the general population, and it is highest in the population of obese women (5). The estimations show that the total IIH widespread presence corresponds to the rate of obesity in an area (1). Regarding the existence of IIH, clinical phenotypes with poor clinical presentation, when there are no diagnostic considerations of the disorder, the real incidence and prevalence rates are estimated to be higher than mentioned (6).The possible etiological parameters of this disorder suggest that the basis for ...