Clinical Spectrum and Management of Idiopathic Intracranial Hypertension

• Published in: Neurosurgery quarterly Vol. 25; no. 3; pp. 374 - 380
• Main Authors: Elsaadany, Waleed F, Farhoud, Ahmed H, Achmawi, Ghada A, Mousa, Wael M, Shahin, Mohamed S
• Format: Journal Article
• Language: English
• Published: Copyright Wolters Kluwer Health, Inc. All rights reserved 01-08-2015
• ISSN: 1050-6438; 1534-4916
• DOI: 10.1097/WNQ.0000000000000064

OBJECTIVE:Diagnosis of idiopathic intracranial hypertension (IIH) is a process of exclusion based on clinical, imaging, and cerebrospinal fluid (CSF) data. The appropriate treatment for this complex disease remains unknown. In this study, we analyzed a series of patients with clinical and imaging presentations of IIH correlating them with CSF pressure data and trying to identify selection criteria for best therapeutic modality.
MATERIALS AND METHODS:Eighty-five cases were included in the study. All patients underwent clinical, imaging, and CSF manometry evaluation. Analysis of data was conducted and parameters suggestive of therapeutic modality were identified.
RESULTS:Sixty patients presented with classic IIH. First opening CSF pressure was mild in 13.33%, moderate in 50%, severe in 16.67%, and fulminant in 20%. Among all patients, 63.33% recovered on medical treatment and 36.67% needed placement of a lumboperitoneal shunt. Twenty-five patients presented with “borderline” IIH. Data for diagnosis includedchronic headache, visual field defects, “ballooned” partial empty sella, and borderline CSF pressure (160 to 200 mm Hg in nonobese, 160 to 250 mm Hg in obese). All patients showed good recovery to medical treatment.
CONCLUSIONS:For classic IIH, medical treatment is recommended for patients with acute presentation as well as mild and moderate opening CSF pressures. Surgery is indicated for patients who fail medical treatment or develop medication intolerance, for patients with subacute and chronic presentations, as well as for patients with severe and fulminant opening CSF pressures. Patients with “borderline” IIH presenting with chronic headache, visual field defects, and “ballooned” partial empty sella respond well to medical treatment.