Journal article
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri): Recognition, Treatment, and Ongoing Management
Current treatment options in neurology, Vol.15(1), pp.1-12
02/2013
DOI: 10.1007/s11940-012-0207-4
PMCID: PMC3554852
PMID: 23136035
Abstract
Idiopathic intracranial hypertension (IIH, pseudotumor cerebri) is a syndrome of elevated intracranial pressure of unknown cause that occurs predominantly in obese women of childbearing age. It is a diagnosis of exclusion and, therefore, other causes of increased intracranial pressure must be sought with history, imaging, and cerebrospinal fluid examination before the diagnosis can be made. IIH produces symptoms and signs of increased intracranial pressure, including papilledema. If untreated, papilledema can cause progressive irreversible visual loss and optic atrophy. The treatment approach depends on the severity and time course of symptoms and visual loss, as determined by formal visual field testing. The main goals of treatment are alleviation of symptoms, including headache, and preservation of vision. All overweight IIH patients should be encouraged to enter a weight-management program with a goal of 5% to 10% weight loss, along with a low-salt diet. When there is mild visual loss, medical treatment with acetazolamide should be initiated. Other medical treatments can be added or substituted when acetazolamide is insufficient as monotherapy or poorly tolerated. When visual loss is more severe or rapidly progressive, surgical interventions, such as optic nerve sheath fenestration or cerebrospinal fluid shunting, may be required to prevent further irreversible visual loss. The choice of intervention depends on the relative severity of symptoms and visual loss, as well as local expertise. At present, the role of transverse venous sinus stenting remains unclear. Although there are no evidence-based data to guide therapy, there is an ongoing randomized double-blind placebo-controlled treatment trial, investigating diet and acetazolamide therapy for IIH.
Details
- Title: Subtitle
- Idiopathic Intracranial Hypertension (Pseudotumor Cerebri): Recognition, Treatment, and Ongoing Management
- Creators
- Matthew J Thurtell - Neurology Service, VA Medical Center, Iowa City, IAMichael Wall - Neurology Service, VA Medical Center, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Current treatment options in neurology, Vol.15(1), pp.1-12
- DOI
- 10.1007/s11940-012-0207-4
- PMID
- 23136035
- PMCID
- PMC3554852
- NLM abbreviation
- Curr Treat Options Neurol
- ISSN
- 1092-8480
- eISSN
- 1534-3138
- Grant note
- U10 EY017281 || EY / National Eye Institute : NEI
- Language
- English
- Date published
- 02/2013
- Academic Unit
- Neurology; Ophthalmology and Visual Sciences
- Record Identifier
- 9983980067802771
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