Update in the Management of Idiopathic Intracranial Hypertension

The management approach for IIH depends on the severity of visual loss on the basis of automated static perimetry, severity of papilledema, severity of symptoms, response to medical therapy, and ability to tolerate medical therapy. Patients with no visual loss (eg, with MD better than -2 dB) can be managed with weight loss alone, although medical therapy may be needed depending on the severity of symptoms and response to weight loss attempts. Patients with mild vision loss (eg, with MD of -2 to -7 dB) can usually be successfully managed with weight loss plus medical therapy. Patients with moderate vision loss (eg, with MD -7 dB to -15 dB) can often be managed with weight loss plus more aggressive medical therapy, although surgical therapy may be needed depending on the response to weight loss and medical therapy. Patients with severe vision loss (eg, with MD worse than -15 dB) often require aggressive medical therapy and consideration for early surgical therapy (eg, CSF shunting, ONSF, or venous sinus stenting), although the selection and timing of surgical therapy remains controversial. Patients with IIH require long-term monitoring, because this is a chronic disease that is prone to relapses in association with weight gain. Because the severity of vision loss, papilledema, and symptoms influences treatment decisions, ophthalmic surveillance is crucial; the timing of follow-up is tailored according to the severity of symptoms and signs at presentation, response to treatment, and subsequent clinical course. A multidisciplinary approach is recommended to optimize management of weight loss, refractory headaches, and coexisting psychosocial issues.

Automated summary

Management of IIH depends on factors such as severity of visual loss, papilledema severity, symptom severity, response to treatment, and tolerance to therapy. Long-term monitoring and a multidisciplinary approach are recommended for IIH patients.