Treatment of idiopathic intracranial hypertension with gastric bypass surgery

Abstract

Idiopathic intracranial hypertension (IIH) is defined by elevated intracranial pressure and associated headaches, changes in vision and pulsatile tinnitus, among other symptoms. It occurs most frequently in young, obese women. Gastric bypass surgery has been used to treat morbid obesity and its comorbidities, and IIH has recently been considered among these indications. We present a case report of a 29-year-old female with a maximum BMI of 50.3 and a 5-year history of severe headaches and moderate papilledema due to IIH. She also developed migraine headaches. After a waxing and waning course and various medical treatments, the patient underwent laparoscopic Roux-en-Y gastric bypass surgery with anterior repair of hiatal hernia. Dramatic improvement in IIH headaches occurred by 4 months postprocedure and was maintained at 1 year, when she reached her weight plateau with a BMI of 35. Presurgery migraines persisted. This adds to the small number of case reports and retrospective analyses of the successful treatment of IIH with gastric bypass surgery, and brings this data from the surgical literature into the neurological domain. It offers insight into an early time course for symptom resolution, and explores the impact of weight-loss surgery on migraine headaches. This treatment modality should be further investigated prospectively to analyze the rate of headache improvement with weight loss, the amount of weight loss needed for clinical improvement, and the possible correlation with improvement in papilledema.

Spontaneous Improvement of Idiopathic Intracranial Hypertension During Pregnancy: Case Report and a Short Literature Review

“…Other risks for serious comorbidities, such as cardiovascular and locomotion system disorders, are reduced or eliminated. Previous authors described successfully treated IIH patients with weight reducing surgery [53,54]. In our patient ICP has also completely normalized six moths after bariatric surgery and subsequent weight loss.…”

Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects

“…Gastric bypass surgery has been demonstrated to improve visual outcomes and reduce ICP in IIH cases with morbid obesity. 71 , 72 …”

Idiopathic intracranial hypertension and bariatric surgery: a systematic review

“…Twelve primary studies [18][19][20][21][22][23][25][26][27][28]30,31 were included in the systematic review, accounting for a total of 39 participants, all of whom were diagnosed with IIH preoperatively. Of the 39 participants, 38 were female, and the average age of all participants was 32.5 years.…”

“…As bariatric surgery remains the only treatment modality that has been proven to be successful for patients with severe obesity for whom conservative management has been unsuccessful, various case reports and case series have identified bariatric surgery as a potential option for patients with IIH. 8,[18][19][20][21][22][23][24][25][26][27][28][29][30][31] We aimed to systematically review the literature to determine the efficacy of bariatric surgery for the treatment of IIH.…”