The expanding spectrum of idiopathic intracranial hypertension
Reviewed by Ivan Yip

This is a review article from a tertiary centre in Atlanta, US. With rising obesity rates and increasing access for MRI scans there has been a large increase in patients requiring an urgent papilloedema check with incidental findings on MRI suggestive of possible idiopathic intracranial hypertension (IIH) or obese patients with chronic headaches. They find 20% of their neuro-ophthalmology referrals were urgent for this reason but with only 27% confirmed to have papilloedema. The burden of ‘rule out IIH’ consultations is already overwhelming and likely to worsen. They agree that the consultations are needed as the morbidity for IIH patients is very high. Patients with papilloedema should have lumbar puncture and treatment which is standardised. Patients who may have signs of previous IIH and no active IIH currently may not require further follow-up or treatment for the intracranial pressure as chronically there are arguments that changes in the skull base with expansion of sella turcica, enlargement of Meckels caves, encephaloceles, cerebrospinal fluid (CSF) leak may be actively compensating and preventing the development of papilloedema. These signs may take years to develop and usually do not change if the pressure is normalised. Symptom management and prevention of meningitis would be the mainstay of treatment. The majority of IIH patients will be obese and there should still be an emphasis on weight loss. The multidisciplinary team (MDT) approach with ophthalmology, neuro-ophthalmology, neurologists, neuroradiologists, ENT, neurosurgeons, nutritionists and bariatric surgeons in management of these patients would help reduce morbidity in these patients.

The expanding spectrum of idiopathic intracranial hypertension.
Biousse V, Newman NJ.
EYE
2023;37(12):2361-4.