Update on the pathophysiology and management of idiopathic intracranial hypertension

Abstract

Idiopathic Intracranial Hypertension (IIH) is a disease of unknown etiology typically affecting young, obese women, producing a syndrome of increased intracranial pressure without identifiable cause. Despite a large number of hypotheses and publications over the past decade, the etiology is still unknown. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding IIH’s pathophysiology. There continues to be no evidence-based consensus or formal guidelines regarding management and treatment of the disease. Treatment studies show that the diagnostic lumbar puncture is a valuable intervention beyond its diagnostic importance, and that weight management is critical. However, open questions remain regarding the efficacy of acetazolamide, cerebrospinal fluid shunting procedures, and cerebral transverse venous sinus stenting.

Primary stabbing headache: a new dural sinus stenosis-associated primary headache?

“…It may open new interesting scenario in the definition of the pathophysiological mechanism and treatment of this primary headache. Venous sinus abnormalities were first associated to idiopathic intracranial hypertension (IIH) [6], an infrequent and enigmatic condition [12] that may run without papilledema (IIHWOP) in a significant percentage of patients [7]. According to an recent evidence [13], IIHWOP can be detected in 11 % of individuals without chronic headache or other signs or symptoms of intracranial hypertension.…”

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

“…15 Idiopathic intracranial hypertension is not well understood, and management of these patients lacks a clear evidence base. 22 Whatever the cause, the higher pulsatile pressures lead to erosion of the skull base with a predilection for the thinnest areas, namely the cribriform plate and lateral sphenoid recess. 19,23 The overall pattern demonstrated for sites of traumatic leaks correlated with a recent series.…”

“…4,20 Further research is required to elucidate if, when, and which adjuvant treatments to employ. 22 These include conservative (diet and weight loss), medical (loop diuretics and carbonic anhydrase inhibitors), radiological (intracranial venous shunting), and surgical (ventriculoperitoneal shunting or bariatric surgery) options. 4,19,20,[39][40][41][42][43][44] Complications included three postoperative episodes of transient pyrexia 24 hours postoperatively with negative blood cultures and no meningitis.…”

Success of Early Surgical Intervention in a Case of Idiopathic Intracranial Hypertension Presented with Nearly Total Vision Loss

“…Immediate invasive management is recommended in cases of severe and sudden vision loss [1,8]. CSF diversion procedures such as ventriculoperitoneal shunting (VPS), ventriculoatrial (VA) or lumboperitoneal (LP) shunting [1] and optic nerve sheath decompression (ONSD) [9] are commonly performed surgical procedures. In this condition, we had planned and performed VPS surgery successfully.…”

“…Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri is a condition of elevated intracranial pressure (ICP) without laboratory pathology or intracranial structural abnormalities in radiological imaging techniques [1,2]. It is usually diagnosed in women at childbearing age but also may be seen in pediatric pupulation [3,4].…”